Pre-Ross Procedure FAQ'S
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.
Can the Ross Procedure be done as a secondary operation after previous aortic valve surgery?
In most cases, the answer is yes. It may be somewhat more difficult, however, due to scar tissue around the heart.
What if the Ross Procedure is technically impossible?
About 1 in 100 people with bicuspid aortic valves also have bicuspid pulmonary valves. In this situation, it is probably not a good idea to use the pulmonary as an aortic valve substitute. This is, unfortunately, almost impossible to determine for sure before the operation because of the limitations of imaging techniques. For that reason, a backup plan should be considered before the operation to avoid confusion. Plan B might be a mechanical valve, a pericardial valve, a stentless porcine, an aortic homograft or even some form of valve repair depending on the specifics of age, anatomy, and patient choice. These possibilities can usually be discussed prior to surgery.
Can the Ross Procedure be done Minimally Invasively?
The extensive reconstruction involved in the operation and the importance of protecting the heart for a longer time make the full sternotomy the best approach for this operation. The skin incision can be shortened on either end for cosmetic purposes. The sternal incision is extremely well tolerated by the young people who are candidates for this surgery and a solid closure
Will I need a blood transfusion?
This depends on the patient, but the answer is probably no. To date, less than 20 percent of patients receiving the Ross Procedure have required a blood transfusion.
Why is the Ross Procedure better than other aortic valve replacement procedures?
- No blood thinners (anticoagulants) are needed. If the aortic valve is replaced with a mechanical valve, the patient must take anticoagulants for the rest of his or her life. These medications have a small risk of excess bleeding or hemorrhage and the effects of the anticoagulants must be monitored with a blood test every 3 or 4 weeks and the dosage adjusted.
- Greater durability of the living human valve.
- Ideal blood flow characteristics of the normal human valve.
What is the success rate of the operation?
In Dr. Stelzer's hands, the mortality risk of the operation is less than 1 percent. Long-term results have been excellent. More than 80 percent of the patients who have undergone this surgery can expect to be alive after 20 years and fewer than 15 percent of patients need additional valve procedures.
Am I too old for a Ross Procedure?
Age is not just a number but a physiologic state. Because the Ross is designed to be a long term solution for aortic valve disease, it is suitable for anyone with at least a 25 year life expectancy. Usually that translates into someone less than 65, but a few older patients have had this operation quite successfully. For older patients, simpler alternatives offer 15-20 year durability and are widely available.
Am I too young for a Ross Procedure?
The very youngest patients are extremely challenging but most of them can be treated with balloon valvuloplasty to buy time. Ideally, it is best to get old enough to allow implantation of an adult size homograft so this does not have to be replaced as a child grows. The pulmonary autograft actually can grow with the child, but it can also overgrow/dilate so this too is best if it can be fixed at an adult dimension. Practically speaking, this is feasible in most children by the age of 10 and certainly by 15.