Post-Ross Procedure FAQ's
What later follow-up is needed?
Before being discharged from the hospital, an echocardiogram is done. An echocardiogram is recommended annually thereafter.
What is the recuperation time?
Usually, a patient is able to go home 3 or 4 days after surgery. After 4 to 6 weeks many patients are able to return to work and resume normal activity, including extensive walking and even jogging. Heavy lifting should be delayed for about 8 weeks.
What if I need another operation some day?
If a Ross patient needs another heart operation, it should be done by someone familiar with the Ross Procedure. The pulmonary homograft tends to stick to the side of the aorta over time and this area can be avoided by proper technique. The closure of the pericardium or use of pericardial substitutes is part of the initial Ross routine that makes any subsequent surgery easier and safer.
Will I have to take medicines after the surgery?
Most patients tend to retain water after heart surgery, so diuretics ("water pills") are frequently prescribed for a couple of weeks. Pain medicine is needed in decreasing amounts over the first couple of weeks as well. Blood pressure needs to be kept low to allow the pulmonary valve to more gently "learn" how to be an aortic valve. It becomes thicker and stronger over a few months but this process is less well organized at the cellular level if the pressure gets too high too soon. Beta blockers such as metoprolol are typically used to help with this. Beta blockers also help to keep the heart rate slower and help prevent irregular rhythms. ACE inhibitors are appropriate if additional blood pressure control is needed and for patients who had severe aortic regurgitation with dilated left ventricles to help optimize the return to normal size and function. Blood thinners are not required at all. Aspirin may be used if a patient required an aortic graft or a mitral ring in addition to the Ross itself.
Will my aorta dilate after the operation?
Patients with bicuspid aortic valves have a higher tendency to aortic dilatation and aneurysm development than people with normal aortic valves. 90% will not have an issue with this, but about 10% may face this. Because of this possibility, if the aorta is dilated at the time of surgery, it will be cut down to size or even replaced. The pulmonary autograft in the aortic position can also dilate, so this is now equipped with special support "collars" on either end to protect the valve and incorporation of extra native aortic wall tissue around it. Some extreme cases are also fitted with a "jacket" of Dacron graft material to prevent dilatation of the new root. A CT scan is a good test for evaluating the size of the aorta but because of the radiation involved should usually only be used at 5-10 year intervals in young people. Echo is safer for annual follow up and gives early warning about dilatation especially at the root level.
What about "extreme" athletics after surgery?
With the exception of extremely heavy weight-lighting, Ross patients have been able to resume all kinds of athletic activities including mountain biking, sky-diving, tennis, swimming, and running. One patient has completed 9 Iron Man Triathlon's in the 14 years since his surgery.