The Ross Procedure for Aortic Valve Replacement

 

Presenter

Charles M. Geller, MD

Charles M. Geller, MD Cardiac Surgeon
Beth Israel Medical Center Dr. Charles M. Geller is an attending cardiothoracic surgeon in the Division of Cardiac Surgery at Beth Israel Medical Center in New York City. Dr. Geller graduated summa cum laude from the Boston University 6-year medical program, jointly receiving BA ...
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The Ross Procedure: A Unique Aortic Valve Replacement Surgery Designed for Younger Patients Who Want to Avoid Blood Thinners and Repeat Procedures

NEW YORK CITY- Each year several thousand Americans under the age of 60 are found to have a stenotic (narrowed) or regurgitant (leaky) aortic heart valve, which will eventually require replacement. Generally, aortic valve replacement is recommended when there are signs and symptoms of a progressive strain on the left ventricle, the main pumping chamber of the heart. Appropriate evaluation by a cardiologist with regular echocardiograms can usually determine when surgery should be done, before any serious heart damage occurs.

A typical aortic valve replacement surgery involves replacing the diseased valve with either a mechanical or animal tissue valve - neither of which is ideal for adults with an anticipated 25 year life expectancy. Mechanical valves are made of a very durable carbon but require the patient to use blood thinning medication for their lifetime to prevent blood clotting. This can pose bleeding risks for a young, active person who may be more prone to cuts and bruises. Tissue valves do not require blood thinners, but, only last approximately 12-15 years in younger patients. This means that patients under 60 will likely require a repeat operation within their lifetime.

Beth Israel Medical Center in New York City, well known for excellence in cardiac surgery, will present a webcast showing the Ross Procedure, an alternative aortic valve replacement technique that offers younger patients the potential for long-term freedom from blood thinners and repeat operations, with no restrictions on physical activity. Dr. Charles M. Geller, cardiac surgeon and Ross Procedure expert, will narrate the procedure, performed at Beth Israel Medical Center's main campus in Manhattan.

The Ross Procedure is performed by replacing a patient's damaged aortic valve with his or her own pulmonary valve (pulmonary autograft). The pulmonary valve is used because it is the patient's own tissue and is almost identical in shape, size and strength to the aortic valve. A patient's own pulmonary valve has a unique durability in the aortic valve position, which minimizes the need for future valve re-replacement, a great advantage over traditional tissue valves.

A preserved pulmonary valve from a human donor (pulmonary homograft) is then put in the pulmonary position. A donor pulmonary valve has proven to be extremely durable in the pulmonary position. It may provide up to 35-40 years of service without replacement since its workload is significantly less on the low pressure right side of the heart.

An ideal candidate for the Ross Procedure is 60 years of age or under, who has isolated aortic valve disease, good left ventricular function, and no other significant medical conditions which might preclude the safety of the operation. While the majority of patients are male, the Ross Procedure is especially suited to women of childbearing years because they do not have to take blood-thinning medication (warfarin or Coumadin, which is known to cause birth defects) to prevent clot formation, which is required with use of a mechanical valve.

Overall, the success rate with the Ross Procedure is approaching 99 percent and long term results have been excellent, with more than 80 percent of patients alive after 20 years and fewer than 15 percent needing further valve procedures.

To make an appointment for a consultation on the Ross Procedure with Dr. Charles M. Geller at Beth Israel Medical Center, please call (212) 420-2584. Visit the Beth Israel Cardiac Surgery website for more information.