The Ross procedure, a specialized technique for aortic valve replacement, is associated with significant long-term durability and positive outcomes in adult patients with aortic valve disease, according to findings published on June 23 in the Journal of the American College of Cardiology. The study was led by Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery for Mount Sinai Health System.
This publication represents the largest North American study on the Ross procedure. Researchers found that when performed by experienced surgeons using tailored techniques at high-volume centers, the operation provides durable results. The findings suggest expanding consideration of the Ross procedure to include adults over 50 and those with aortic regurgitation—groups previously considered less suitable.
The Ross procedure involves replacing a patient’s diseased aortic valve with their own pulmonary valve. This approach provides a living autologous valve that adapts to physiological demands, differing from conventional tissue or mechanical valves, which lack repair capacity and may require lifelong anticoagulation or risk deterioration over time. According to Dr. El-Hamamsy, “The fundamental advantage of the Ross procedure is that it restores a living valve to the aortic position. That distinction translates into unique long-term benefits for patients.”
The study followed 455 adults who underwent the Ross procedure between 2011 and 2019 under Dr. El-Hamamsy’s care. Patients had regular clinical evaluations and annual echocardiograms; half were older than 50 years old and some were as old as 67. At twelve years post-surgery, survival matched that of the general population; more than 96 percent did not require cardiac reintervention and more than 98 percent had no significant dysfunction of their new valves.
Comparing outcomes between patients with different types of heart valve disease revealed no differences in function or need for reintervention at twelve years—an outcome not previously observed in this population group. “These results demonstrate that use of a tailored surgical approach in patients with aortic regurgitation can eliminate differences in long-term outcomes,” said El-Hamamsy.
El-Hamamsy emphasized that successful results depend on surgeon experience and institutional expertise: “These outcomes reflect the work of a dedicated multidisciplinary team and a mature Ross program... The Ross procedure is ... technically demanding ... [and] should be performed in experienced, high-volume centers committed to comprehensive patient care and close follow-up.”
