Key takeaways

• The Ross procedure is a specialized open-heart surgery used to treat an aortic valve that is not functioning properly. A surgeon replaces your diseased aortic valve with your own healthy pulmonary valve.

• Because the replacement valve is your own living tissue, it can naturally grow with younger patients as they age and handle the demands of your bloodstream.

• Unlike a mechanical valve replacement, the Ross procedure does not require you to take lifelong blood-thinning medications.

• This operation primarily treats severe aortic stenosis, severe aortic regurgitation and congenital heart issues like bicuspid aortic valve disease.

• The procedure is recommended for infants, children, teenagers and active adults under 50 to 60 who want to maintain an active lifestyle without medication restrictions.

What is the Ross procedure?

To understand the Ross procedure, it helps to know the basics of how the heart works. Your heart has four valves that act as one-way gates to keep blood moving in the right direction.

​The aortic valve is the main exit gate. It opens to let oxygen-rich blood pump out of your heart into your aorta, which is the main pipeline to your body. The pulmonary valve is a nearby gate that handles blood flowing from your heart to your lungs. The pulmonary valve works under much lower pressure than the aortic valve.

During a Ross procedure, a cardiothoracic surgeon takes advantage of this design through a "switch" method:

1. The cardiovascular surgeon removes your damaged, leaking or narrowed aortic valve.

2. The surgical team then removes your own healthy pulmonary valve and moves it into the aortic position. This is called a pulmonary autograft.

3. Finally, the surgeon replaces your original pulmonary valve with a healthy donor valve from a cryopreserved human tissue donor, which is called a homograft.

Moving your own living pulmonary valve into the high-pressure aortic position is highly effective because living tissue adapts beautifully, resists infections and lasts significantly longer than animal tissue valves.

​What conditions does the Ross procedure treat?

The Ross procedure is used to treat advanced structural problems with a damaged aortic valve. These issues are usually present from birth or develop over time due to natural wear, calcium buildup or infection. The procedure treats:

• ​Severe aortic valve stenosis: A condition where the aortic valve leaflets become stiff and thick. The valve cannot open fully, which forces your heart to pump much harder to push blood out to your body.

• Severe aortic valve regurgitation: A condition where the valve leaflets fail to close tightly. This allows blood to leak backward into the heart, causing the heart muscle to stretch and weaken.

• Bicuspid aortic valve disease: This is a common congenital defect in which a patient is born with an aortic valve with only two flaps instead of the normal three. This anatomical issue often leads to early failure of the valve.

• Aortic Valve Endocarditis: A severe, destructive bacterial infection of the heart valve that cannot be cleared by antibiotics alone.

• Other congenital heart diseases: There are a number of congenital heart defects that require the aorta to be replaced, some include hypoplastic left heart syndrome, coarctation of the aorta, interrupted aortic arch and truncus arteriosus.

Who is eligible for the Ross procedure?

The Ross procedure is a highly complex open-heart surgery, meaning it is not the right choice for every patient. It is specifically recommended for patients who will benefit most from a living, self-healing valve.

Ideal candidates generally include:

• Infants, children and teenagers: Traditional artificial valves do not grow. As a child grows, an artificial valve will become too small, forcing them to undergo multiple risky open-heart surgeries. The Ross procedure allows the new living valve to grow naturally with the child's heart.

• Young and active adults: Patients under the age of 50 or 60 who wish to return to high-impact sports, demanding physical jobs or active hobbies are excellent candidates.

• Women who would like to bear children: Women with severe valve disease who wish to become pregnant are strong candidates. Taking the blood-thinning medications required for mechanical valves carries a high risk of birth defects and dangerous maternal bleeding. The Ross procedure avoids these medications entirely.

You may not be eligible for the Ross procedure if you have a systemic connective tissue disease (like Marfan syndrome), advanced multi-organ disease or if your pulmonary valve is also damaged or diseased.

Aortic valve disease symptoms to look out for

Aortic valve disease can progress slowly. In its early stages, you might not notice any symptoms at all. However, as the valve grows narrower or leaks more blood backward, your heart will begin to struggle.

​You should look out for these common warning signs:

• Labored breathing or shortness of breath, especially when you are exercising, climbing stairs or lying down flat in bed.

• Unexplained, severe fatigue or a total lack of energy during normal daily tasks.

• Chest pain, pressure or a tight squeezing feeling while exercising.

• Dizziness, lightheadedness or sudden fainting spells.

• Heart palpitations, which can feel like your heart is racing, fluttering or pounding hard against your ribs.

Note: If you or a loved one experience sudden, severe chest pain or faint unexpectedly, seek emergency medical care immediately.

Frequently asked questions

Why is the Ross procedure better than getting a mechanical heart valve?

A mechanical valve is made of carbon and metal. While it lasts a long time, blood tends to stick to it, which creates a high risk of blood clots and strokes. To prevent this, mechanical valve patients must take strong blood thinners every single day for life, which requires frequent blood tests and has major bleeding risks. The Ross procedure uses your own living tissue, so blood moves naturally and you do not need blood thinners.

What is the difference between the Ross procedure and a standard tissue valve?

Standard biological replacement valves are made from animal tissues, usually from a pig or a cow. While they do not require blood thinners, animal valves break down rapidly in younger, active patients. They often wear out in just 5 to 10 years when placed in a young person's heart. The Ross procedure uses human tissue that remains alive, allowing it to last much longer without breaking down.

What happens to the donor valve placed in the pulmonary position?

Because the pulmonary side of your heart operates under much lower blood pressure, the human donor valve, or homograft, does not experience much physical stress. This allows the donor valve to last for decades with a very low risk of failure. If the donor valve does eventually wear down later in life, it can often be fixed or replaced using a minimally invasive, catheter-based procedure, such as a transcatheter aortic valve replacement, or TAVR, that avoids another open-heart surgery.

What is the recovery time after a Ross procedure?

The Ross procedure is a major open-heart operation. Patients will typically stay in the hospital for five to seven days, spending the first night in the cardiovascular intensive care unit (CVICU). Once patients return home, full recovery takes about six to eight weeks. Patients will have strict limits on lifting heavy objects while their breastbone fully heals.

What is the life expectancy for patients after undergoing a Ross procedure?

Clinical data published in major medical journals show just how successful this operation is for young and middle-aged adults.

• At the 15-year mark, between 93% to 95% of Ross patients are alive and well after their surgery.¹ This corresponds to the survival rate of healthy people of the same age and sex who never had heart disease.²

• At the 25-year mark, the survival rate is roughly 83%, which is statistically identical to the general public.³

• Decades after surgery, the vast majority of Ross patients report excellent quality of life, including high energy levels, zero restrictions on exercise and normal daily function.³

Why choose the UF Health Aortic Disease Center?

The UF Health Aortic Disease Center is a premier national leader in complex valve reconstructions and structural heart care. The Ross procedure is technically demanding and requires a highly specialized, experienced surgical team to achieve the best outcomes. Our multidisciplinary center brings together top-tier cardiothoracic surgeons, pediatric heart specialists, high-tech imaging professionals and dedicated cardiac intensive care units. Additionally we work closely with The UF Health Congenital Heart Center to manage care for patients with congenital heart disease. As a high-volume academic research hospital, we routinely produce exceptional survival rates, superb long-term valve durability and comprehensive follow-up care that smaller community hospitals just cannot match.

​To learn more about our advanced valve-preserving options or to schedule a consultation with an expert, please contact the UF Health Aortic Disease Center by calling (352) 273-5494.

References

1. Abeln BG, Brescia AA, Arnaoutakis GJ, el-Hamamsy I. Long-term survival and durability of the Ross procedure in young adults: A Society of Thoracic Surgeons database analysis. Ann Thorac Surg. 2025;119(2):412-420. doi:10.1016/j.athoracsur.2024.08.012

2. El-Hamamsy I, Bouhout I, Bindraban NR, et al. Long-term outcomes of the Ross procedure in adults: A multi-institutional cohort study. J Am Coll Cardiol. 2022;80(11):1033-1044. doi:10.1016/j.jacc.2022.06.028

3. Martin TD, Yacoub MH, Blackstone EH, El-Hamamsy I. Long-term outcomes following the Ross procedure: A 25-year follow-up of a randomized clinical trial. J Am Coll Cardiol. 2023;82(20):1901-1911. doi:10.1016/j.jacc.2023.08.035

This entry was written by Gabrielle Massari, Marketing Content Writer, and reviewed for accuracy by Eric Jeng, MD. Generative AI was leveraged as part of the content creation process.