Aortic Valve Procedure (Ross Procedure) Gives 29-Year-Old's Heart a Second Chance at Life

Surgeons at Baptist Health Miami Cardiac & Vascular Institute are now performing the Ross Procedure, an aortic valve operation that can restore normal life expectancy — and reduce the chance of heart failure — for many young and middle-aged adults with aortic valve disease. The Institute’s Center for Aortic Care is the first in Miami outside of a congenital heart program to offer the surgery.

In a healthy heart, the aortic valve opens to allow oxygen-rich blood to move from the heart to the rest of your body. It closes to prevent blood from going backward into the heart as it beats. People with aortic valve disease often feel short of breath, fatigued, have chest pain, experience dizziness or lightheadedness and have swollen ankles and feet. Some people are born with aortic valve disease (congenital), others develop the disease later in life.

What is the Ross Procedure?

During a Ross Procedure, surgeons remove the damaged, nonfunctioning aortic valve and replace it with the patient’s own pulmonary valve. Then, a healthy donor pulmonary valve takes the place of the original pulmonary valve.

“Using the patient’s own pulmonary valve reduces the risk of deterioration that can come with an artificial aortic valve and ensures a better fit,” explains Mehrdad Ghoreishi, M.D., co-director of aortic surgery and medical director of cardiac surgery research at Miami Cardiac & Vascular Institute. “It takes about six months for the patient’s own pulmonary valve to thicken, become stronger and begin to behave like an aortic valve.”

Another advantage to using the patient’s own valve is that there’s no need for the blood-thinners or anticoagulants that are necessary following the placement of a mechanical aortic valve. The risk of infective endocarditis is almost near zero with the Ross Procedure, compared with aortic valve replacement with artificial valves (tissue or mechanical valves).

Who is a Candidate for the Ross Procedure?

Patients who may benefit from the Ross Procedure include those who are under age 60 and:

·      Have a unicuspid, bicuspid or tricuspid aortic valve with aortic stenosis (narrowing) or aortic insufficiency (regurgitation)

·      Aortic valve endocarditis

·      Other types of aortic valve disease

It is not an option for patients with autoimmune or connective tissue disorders, coronary artery disease affecting three or more arteries or pulmonary valve disease.

The Institute’s first Ross Procedure patient was 29-year-old Juan Fuentes, who was born with a  unicuspid aortic valve. “Before the surgery, I would get exhausted very quickly after working or walking,” the Homestead resident said. “My heart would speed up very quickly.”

Mr. Fuentes returned home seven days after surgery and is doing well. “Now I walk for a half hour or for an hour,” he said. “I feel very, very happy. I feel much better now.”

While the Ross Procedure isn’t new, few physicians are trained to perform the surgery because of its complexities. 

Mehrdad Ghoreishi, M.D., co-director of aortic surgery and medical director of cardiac surgery research at Miami Cardiac & Vascular Institute

“After surgery, patients are followed very closely,” Dr. Ghoreishi says. “It’s very important that they control their blood pressure throughout their lifetime, so they are monitored and assessed regularly.” After recovery, patients generally have no exercise or lifestyle restrictions.

Data from a long-term study of Ross Procedure patients, published in multiple peer-reviewed journals, showed survival rates of 95 percent at 15 years. Few patients needed reintervention. It’s important, Dr. Ghoreishi added, that the Ross Procedure be performed by an experienced surgeon at centers with multidisciplinary teams.