The Ross Operation Comes of Age

Abstract

Approximately 50 years ago, I witnessed the birth of the Ross operation at the National Heart Hospital in London, United Kingdom, and began to watch it grow. There have been many so-called growing pains, but as is usual, these represent a passing phase. The origins of the operation stems from the hypotheses, advanced by Donald Ross, MB, ChB, FRCS, that a living valve substitute is essential for the valve's long-term performance, the normal pulmonary valve shares many structural and functional characteristics with the normal aortic valve, and substitution had to be autologous to avoid rejection. These ideas were greeted by great skepticism. It has taken about 50 years to prove that Ross was right on all 3 accounts. [1][2][3][4] Despite that, use of the Ross operation remained extremely low until very recently. This was thought by many experienced workers to be a lost opportunity. 5 The article by Mazine et al 6 in this issue of JAMA Cardiology is a welcome addition to the accumulating evidence of the superiority of the Ross operation. The authors present the first and to my knowledge only meta-analysis comparing outcomes of the Ross operation with those of mechanical prostheses (currently the recommended and most common aortic valve substitute) in young and middle-aged adults. For the analysis, the authors used several important solid end points, including survival, quality of life, hemodynamic performance, and changes in left ventricular size and function, as well as frequency of reoperation. The Ross operation outperformed mechanical valves at all end points except for the frequency of reoperation, which was marginally increased relative to mechanical protheses. Fortunately, the causes of reoperation are largely preventable and, when they occur, can

The Ross procedure—the loose jacket technique

“…The Ross operation is the only operation which guarantees long-term viability of the aortic valve substitute. This translates into enhanced durability, survival, exercise capacity and quality of life and minimal valve related complications (1,2). However, there is continuing concern about progressive autograft dilatation, particularly when used as a freestanding root (3).…”