Ross Procedure

What is the Ross procedure?

The Ross procedure is a type of heart valve surgery used to treat severe aortic valve disease. This procedure is a type of aortic valve replacement surgery developed in the 1960s by a British surgeon named Donald Ross, and has been continually refined over the years to maximize its medical benefits.

The aortic valve, which is replaced in the Ross procedure, is one of the four valves of the heart. It sits inside the heart’s main pumping chamber, the left ventricle, and moves blood out of the heart and into the body’s main artery, the aorta. The valve plays a key role in circulation and works hard, opening and closing with each heartbeat.

During the Ross procedure, your surgeon:

1. Removes the damaged aortic valve
2. Replaces it with your own healthy pulmonary valve, which is the valve that normally controls blood flow from the heart to the lungs
3. Implants a donor valve to replace your pulmonary valve

This unique approach allows your own valve to function in the high-pressure environment between the heart and aorta. This offers better blood flow and long-term valve durability and performance compared to traditional valve replacements like prosthetic and donor aortic valves.
 

When is the Ross procedure needed?

For some people with aortic valve disease, repair may be possible—but when repair isn't an option, replacement procedures like the Ross offer durable results and excellent long-term outcomes. The Ross procedure is usually recommended for healthy active patients who have a damaged or diseased aortic valve and need it replaced. This might be due to a condition the patient is born with (like a bicuspid aortic valve), an infection, or other valve problems that cause the valve to leak (aortic regurgitation or insufficiency) or to narrow (aortic stenosis).

The procedure is often considered by people who want to avoid lifelong blood-thinning medications and stay active, since it uses your own healthy valve tissue and tends to last longer than other types of valve replacements. The Ross procedure is the one type of aortic valve replacement that has been shown to restore a normal like expectancy to an age-matched population. This means that, generally, the Ross procedure does not have a negative effect on life expectancy, whereas other types of aortic valve replacement may result in a decrease in life expectancy.

Am I a candidate for the Ross procedure?

You may be a candidate for the Ross procedure if you:

• Have severe aortic valve disease (such as aortic stenosis or aortic regurgitation)
• Are otherwise healthy and a good candidate for heart surgery
• Have already undergone aortic valve replacement and need reoperation

Your heart team at Mass General Brigham will evaluate your overall health, valve anatomy, and surgical goals to determine if this treatment option is right for you.

Who is not eligible for the Ross procedure?

The Ross procedure isn’t right for everyone. It may not be recommended for patients with certain heart conditions, such as disease affecting multiple heart valves, or for those with connective tissue disorders like Marfan syndrome. It may also be less suitable for older adults or people with other health issues that increase surgical risk. Your heart surgeon will carefully evaluate your individual health and anatomy to determine if the Ross procedure is the best option for you. 

What are the benefits of the Ross procedure?

The Ross procedure offers many of the same life-enhancing benefits as other valve replacements, including:

• Improvement in heart function
• Improved blood flow
• Relief from symptoms like shortness of breath or fatigue
• Increased energy

But unlike other procedures, the Ross procedure uses your own healthy pulmonary valve to replace your damaged aortic valve, offering several unique advantages:

• Your new aortic valve is made from your own living tissue, which tends to function more naturally and is highly durable over the long term.
• There’s a lower risk of blood clots, so most patients do not need to take lifelong blood-thinning medication.
• The risk of valve infection is lower compared with mechanical or bioprosthetic valves.
• It may allow for better physical performance, which is especially important for younger or more active patients.
• The Ross procedure is the only aortic valve replacement procedure that has been associated with restoration of normal life expectancy.

Overall, the Ross procedure not only improves heart function, it helps patients feel better, live more actively, and avoid complications sometimes associated with synthetic valves.

What are the risks of the Ross procedure?

Like any heart surgery, the Ross procedure comes with some risks. These may include bleeding, infection, irregular heart rhythms, or complications from anesthesia. Because the procedure involves two heart valves—removing the diseased aortic valve and transplanting your own pulmonary valve—it can be more complex than other valve surgeries.

In rare cases, either valve may need to be repaired or replaced again in the future. There is about a 1% per year risk of requiring reintervention after the Ross procedure. These reinterventions are often able to be performed without open heart surgery using catheter-based techniques, although there are times when reoperation is necessary. Your Mass General Brigham surgical team will carefully evaluate whether the Ross procedure is right for you and will discuss the benefits and risks based on your personal health and goals.  

What can I expect during the Ross procedure?

Why choose Mass General Brigham?

Mass General Brigham offers advanced heart valve care from some of the nation’s leading cardiac surgeons. Our specialists are highly experienced in performing the Ross procedure and other complex valve surgeries, and we continue to refine the technique to improve outcomes. Volume matters for complex surgical procedures, and our team performs the Ross procedure with a frequency that is unparalleled in the region, if not the world. Our surgeons apply the latest advances in the operating room, using advanced methods to increase the durability of the donor valve, providing structural reinforcement to prevent dilation, and closely monitoring patients after surgery to support healing and prevent complications.

Mass General Brigham patients benefit from access to innovative research, including studies aimed at understanding why certain cardiac procedures succeed in some people and not others, so we can continue improving care for future patients.

We provide our patients with individualized care, long-term follow-up, and access to the latest research and clinical trials. Mass General Brigham hospitals consistently rank among the top heart and vascular care centers in the country, and through our system-wide Heart and Vascular Institute, we bring academic expertise and compassionate care to patients across New England.

For referring physicians

Our team welcomes collaboration with referring providers. We offer timely consultations, advanced diagnostics, and expert surgical care—with a strong focus on continuity, communication, and shared decision-making.

To refer a patient, please submit a referral through the Mass General Brigham provider portal.