Maryland Heart Center

Minimally Invasive Aortic Valve Surgery

The Ross Procedure, Homograft, and New Stentless Tissue Valve

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These three procedures are grouped because they offer similar advantages. These advantages have to do with the patient retaining normal physiology after surgery, which makes these the procedures of choice for the young, athletes and anyone who wants to maintain an active lifestyle.

The Ross Procedure uses the patient's pulmonary valve to replace his or her aortic valve. The pulmonary valve is then replaced with a human cadaver valve.

The homograft procedure involves replacing the aortic valve with a human cadaver donor valve with its own support structure in place. The stentless valve procedure involves replacing the aortic valve with a valve taken from a pig. In a stentless valve there are no stents or framework other than normal anatomy.

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Stentless tissue valves and homografts have the advantage of excellent long-term performance. These valves behave physiologically like a normal aortic valve relieving a blockage across the aortic valve. These valves also appear to last the longest of all the tissue valves, with a chance for a repeat surgery 10 years later of only 10%. This possibility of repeat surgery needs to be balanced against the need for lifelong blood-thinning medication in the case of mechanical valves.

All three procedures have the advantage of normal physiology after surgery. That is, these three valve-replacement options result in the minimal gradient across the valve at rest and with activity (i.e., they maximize performance). This feature makes them the procedure of choice for the young or the young-at-heart older patient who wants to continue an active, even athletic lifestyle.

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