Horse Surgery - Information and Specialists

Doctors often treat congenital aortic valve stenosis with an artificial valve replacement. The Ross procedure has established itself as a minimally invasive and successful treatment alternative, particularly for children and adolescents.

A child’s heart continues to grow as the body develops, so artificial heart valves quickly reach their functional limits. In the Ross procedure, doctors replace the damaged aortic valve with the body’s own pulmonary valve. It continues to grow along with the body.

Since the replacement valves in the heart are made from the patient’s own tissue or donor tissue, children can resume sports without restriction after the postoperative recovery phase. Additionally, children who undergo the Ross procedure do not need to take blood-thinning medications for the rest of their lives.

Children and adolescents who suffer from a rare genetic disorder, Marfan syndrome, are not candidates for the Ross procedure. 

Marfan syndrome is a hereditary condition characterized by weakness of the connective tissue. As a result, the natural development of the skeletal and cardiovascular systems is impaired. 

The eyes may also be affected. Damage to the heart valves, including aortic valve stenosis, is part of the typical clinical picture of Marfan syndrome. 

Therefore, in children and adolescents who have undergone a Ross procedure, it is likely that further or recurrent valve disorders will occur. In such cases, artificial aortic valve replacement is the treatment of choice.

Furthermore, patients with inflammatory diseases and/or malignant hypertension (treatment-resistant high blood pressure) are not suitable candidates for the procedure.

Imaging of the valve defect is performed using a special type of cardiac ultrasound (echocardiography). In adult patients, an additional catheter examination of the left heart is usually performed. During this procedure, physicians rule out coronary artery disease as well as further stenoses in the heart and aorta.

Echocardiography (also known as a heart ultrasound) helps doctors make an accurate diagnosis @ Peakstock /AdobeStock

The procedure is performed using a heart-lung machine. Doctors stop the heart for the duration of the Ross procedure; the heart-lung machine takes over breathing and heartbeat in the meantime. 

First, they remove the damaged aortic valve. They then remove the patient’s pulmonary valve and implant it in place of the aortic valve.

At the end of the Ross procedure, the doctors replace the transplanted pulmonary valve with a donor valve. Since the donor pulmonary valve is foreign to the body, it does not grow with the patient. 

For this reason, doctors often implant a slightly larger pulmonary valve so that children and adolescents can benefit from it for as long as possible.

In the Ross procedure, doctors replace the diseased aortic valve with the patient’s own pulmonary valve @ Dee-sign /AdobeStock

In the hands of experienced heart specialists, the Ross procedure is hardly any riskier than the implantation of an artificial heart valve. However, during the Ross procedure, surgeons replace two heart valves (the aortic valve and the pulmonary valve) at the same time, which prolongs the duration of the surgery. 

This can lead to a higher blood transfusion requirement during surgery, as well as postoperative bleeding or the need for a pacemaker.

As with other transplant procedures, the transmission of viral pathogens from the donor to the recipient is possible. Nevertheless, the risk of this is very low. 

This could lead, among other things, to infection with hepatitis B virus (HBV), hepatitis C virus (HCV), or other viruses. Suitable heart valve donors are rare in Germany, so there is limited availability of replacement pulmonary valves.

Particularly in children and adolescents, the body’s own aortic valve replacement may leak after surgery, leading to aortic valve insufficiency. 

It is also not uncommon for the donor pulmonary valve to calcify, leading to recurrent stenosis or valve insufficiency.

In specialized cardiac surgery centers, the Ross procedure has a good prognosis. Young patients achieve a normal life expectancy following a successful operation. 

However, the following are still important and necessary:

• Lifelong cardiological follow-up
• Endocarditis prophylaxis

The Ross procedure is a surgical procedure in cardiology—or, more specifically, cardiac surgery. Specialists in the Ross procedure are therefore cardiologists who work at specialized cardiac surgery centers.