Don’t be surprised to hear about more CHDers having the Ross Procedure to repair a damaged Aortic Valve. Invented by British surgeon Donald Ross in 1967, the Ross procedure is performed on roughly 1500 patients each year.
During the Ross Procedure, both the Aorta and the Pulmonary Artery are clamped and cut near the junction with the heart. The damaged Aortic Valve is then removed and discarded. The Pulmonary Valve is then removed and sewn into the Aortic Valve’s place. A frozen Pulmonary Valve (previously removed from a cadaver) is then reanimated and sewn into the opening left by the original Pulmonary Valve. In the final step, the Aorta and the Pulmonary artery are then sewn back into place. If this is a little confusing, here’s a helpful diagram.
It does seem a little strange – if you recall our memory trick for remembering the proper order of the valves, it’s “Three People Might Agree” – blood flows normally through the Tricuspid Valve, then the Pulmonary Valve, out to the lungs and back to the heart; through the Mitral Valve, and finally through the Aortic Valve and out to the body. T – P – M – A, or Three People Might Agree. If you follow the route after a Ross Procedure, you go through the Tricuspid, Pulmonary, Mitral, and another Pulmonary… Three People Might People! That makes no sense! But it works.
New research has shown that the Ross Procedure has a high survival rate, and the cadaver valve works well – after 20 years, 80% of Ross patients did not need replacement of either Pulmonary Valve. The operation also has the advantage of growing with the patient (great for children!) and no need for anticoagulation… Goodness knows, I wish I didn’t have to have an INR test ever few weeks!