Doctors often treat congenital aortic valve stenosis with the help of an artificial valve replacement. The Ross operation has established itself as a gentle and successful treatment alternative, particularly for children and adolescents.
Children's hearts continue to grow as they develop physically, which is why artificial heart valves quickly reach their functional limits. In Ross surgery, doctors replace the damaged aortic valve with the body's own pulmonary valve. It continues to grow together with the body.
As the replacement valves in the heart are made of the body's own or donor tissue, sport is possible again without restriction after the post-operative recovery phase. In addition, children do not have to undergo lifelong anticoagulation with blood-thinning medication after Ross surgery.
Children and adolescents who suffer from a rare genetic disorder, Marfan syndrome, are not eligible for Ross surgery.
Marfan syndrome is a hereditary weakness of the connective tissue. As a result, the natural development of the bone and cardiovascular system is impaired.
The eyes can also be affected. Damage to the heart valves, including aortic valve stenosis, is a typical clinical picture of Marfan syndrome.
It can therefore be assumed that children and adolescents who have undergone Ross surgery will suffer further or renewed valve disorders. In this case, artificial aortic valve replacement is the treatment of choice.
In addition, patients with inflammatory diseases and/or malignant hypertension (treatment-resistant high blood pressure) are unsuitable for the procedure.
Imaging of the valve defect is carried out using a special cardiac ultrasound (echocardiography). In adult patients, an additional catheter examination of the left heart is usually carried out. This allows doctors to rule out coronary heart disease and further stenoses in the area of the heart and aorta.
Echocardiography (also known as cardiac ultrasound) helps doctors to make an accurate diagnosis @ Peakstock /AdobeStock
The procedure is performed on a heart-lung machine. Doctors immobilize the heart for the duration of the Ross operation and the heart-lung machine takes over breathing and heartbeat in the meantime .
Initially, they remove the damaged aortic valve. They then remove the patient's pulmonary valve and insert it in place of the aortic valve.
At the end of the Ross operation, the doctors replace the repositioned pulmonary valve with a donor valve. As the donor pulmonary valve is foreign to the body, it does not grow with the patient.
For this reason, doctors often insert a slightly larger pulmonary valve so that children and adolescents can benefit from it for as long as possible.
In a Rossoperation, doctors replace the diseased aortic valve with the patient's own pulmonary valve @ Dee-sign /AdobeStock
In the hands of experienced heart specialists, Ross surgery is hardly riskier than the use of an artificial heart valve. However, surgeons replace two heart valves (the aortic valve and the pulmonary valve) together during Ross surgery, which extends the operation time.
This can result in a higher blood requirement during the operation as well as post-operative bleeding or the need for a pacemaker.
As with other transplantation procedures, the transmission of viral pathogens from the donor to the recipient is possible. However, the risk of this is very low.
For example, infection with hepatitis B viruses (HBV), hepatitis C viruses (HCV) or others could occur. Suitable heart valve donors are rare in Germany , which is why there is a low availability of replacement pulmonary valves.
In children and adolescents in particular, the body's own aortic valve replacement can leak after the operation, leading to aortic valve insufficiency.
It is also not uncommon for calcification of the donor pulmonary valve to occur, leading to renewed stenosis or valve insufficiency.
In specialist cardiac surgery centers, Ross surgery has a good prognosis. Young patients achieve a normal lifespan after successful surgery.
However, it is still important and necessary:
- Lifelong cardiological monitoring
- Endocarditis prophylaxis
Ross surgery is one of the surgical procedures in cardiology, or more precisely in heart surgery. Ross surgery specialists are therefore cardiologists who work at specialized cardiac surgery centers.
