Ross procedure

Some patient’s require a new aortic valve.  Their own aortic valve may be defective for a number of different reasons, such as being too leaky, or being too narrow or tight. The Ross procedure is a surgery that addresses patients that need a new aortic valve. The surgery involves using the patient’s own pulmonary valve to replace their own aortic valve, and then using a biologic or mechanical valve to replace the pulmonary valve.  This complicated surgery is done to benefit the patient. By placing the patient’s own pulmonary valve in the aortic position, the patient can avoid anti-clotting medications. In addition, the new aortic valve, being the patient’s own native tissue, can continue to grow as the patient grows, helping the patient avoid additional surgeries.

The Norton Children’s Heart Institute team has the skill and experience to provide care plan for your child who needs a new aortic valve.

The board-certified and fellowship-trained specialists at Norton Children’s Heart Institute, affiliated with the University of Louisville, are the leading providers of pediatric heart care in Louisville and Southern Indiana.

The Society of Thoracic Surgeons has ranked Norton Children’s Heart Institute’s pediatric heart care among the best in the region. Norton Children’s has a network of outreach diagnostic and treatment services conveniently located throughout Kentucky and Southern Indiana.

When does a child need a Ross procedure?

Aortic valves can be abnormal in a number of different ways.  One such way is that the valve is too leaky.  Normally, the aortic valve opens to allow blood to flow into the aorta and then closes to prevent blood from flowing back into the left ventricle. When an aortic valve is leaky and doesn’t close as it should, blood leaks back into the left ventricle. Over time, the ventricle becomes bigger and the heart must work harder to move the blood out to the body.

Another way an aortic valve can be abnormal is when it is fused together or hardened, where it will not open enough.  This is called aortic stenosis.  Aortic stenosis can lead to an obstruction that will force the heart’s lower left chamber (left ventricle) to work harder to pump blood into the aorta. Some patients with aortic stenosis will have a balloon valvotomy, a less invasive procedure that can open the valve.

When aortic valve disease is not manageable through medications or less invasive procedures, the Ross procedure is a surgical option to address severe aortic valve disease.  This surgery involves using the patient’s own pulmonary valve to replace their own aortic valve, and then using a biologic or mechanical valve to replace the pulmonary valve.  This complicated surgery is done to benefit the patient.  By placing the patient’s own pulmonary valve in the aortic position, the patient can avoid anti-clotting medications.  In addition, the new aortic valve, being the patient’s own native tissue, can continue to grow as the patient grows, helping the patient avoid additional surgeries.

Our specialists at Norton Children’s Heart Institute will be able to discuss the risks and benefits of performing the Ross procedure versus a conventional valve replacement with you and your child so you can make the best decision for their future.

What happens during a Ross procedure?

  • Your child gets anesthesia before the surgery. A fellowship-trained pediatric cardiac anesthesiologist cares for every child who has surgery at Norton Children’s Hospital. Your child will sleep and feel no pain.
  • The Ross procedure takes several hours.
  • The surgeon will make a cut down the middle of your child’s chest. The surgeon will separate the breastbone to reach the heart.
  • Your child will be connected to a heart-lung machine during the surgery. The machine does the work of your child’s heart and lungs during the surgery.
  • The surgeon removes the abnormal aortic valve and the pulmonary valve.
  • The surgeon attaches the pulmonary valve where the aortic valve used to be.
  • The surgeon attaches a donor pulmonary valve between the right ventricle and the pulmonary artery.
  • The heart-lung machine is removed once all repairs are done and your child’s heart is beating normally.
  • The breastbone is put back together with wires.
  • The surgeon closes the muscle and the skin.
  • The surgery site is covered with a bandage dressing.

Ross procedure after-care

After surgery, you can expect that your child:

  • May need a breathing tube for a period of time.
  • May be groggy and disoriented when he or she wakes up.
  • Will be closely watched. Doctors and nurses will focus on your child’s heart rate, breathing, blood pressure and oxygen levels.
  • Will feel some soreness, but should not feel severe pain. Medicines are available to help with pain if needed.
  • May be able to drink as soon as the day after surgery. Your child can have regular foods as soon as he or she is able to eat without feeling sick.
  • Will likely be in the hospital for two to three weeks.

Most of the time, symptoms improve soon after surgery. Your child should be able to get back to his or her daily activities relatively soon. Your child may have some limits if he or she plays sports. Your child will need lifelong follow-up care with a pediatric cardiologist to watch for possible complications. Your child also may need to take antibiotics before certain medical or dental procedures to prevent an infection of the heart valves.

Sometimes, the repair may not last for the rest of the patient’s life. Another surgery may be needed due to issues such as:

  • The new aortic valve becomes leaky over time
  • The donor pulmonary valve doesn’t grow with the child and needs to be replaced.

Our specialists at Norton Children’s Heart Institute will be able to discuss the risks and benefits of additional procedures after the Ross procedure so you and your child can make the best decision for your child and their future.

Why choose Norton Children’s Heart Institute

No other congenital heart surgery program in Kentucky, Ohio or Southern Indiana is ranked higher by the Society of Thoracic Surgeons than the Norton Children’s Pediatric Cardiothoracic Surgery Program.

  • Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
  • Our board-certified and fellowship-trained pediatric cardiovascular surgeons are leaders in the field as clinicians and researchers.
  • More than 5,000 children a year visit Norton Children’s Heart Institute, affiliated with the University of Louisville, for advanced heart care.
  • Norton Children’s Heart Institute successfully performs more than 17,500 procedures a year.
  • The Society of Thoracic Surgeons ranked Norton Children’s Heart Institute among the best in the region after studying years of our patients’ outcomes and our ability to handle a range of pediatric heart conditions, including the most severe.
  • Norton Children’s Heart Institute has satellite outpatient centers in Bowling Green, Frankfort, Owensboro and Paducah; 28 tele-echocardiography locations in Kentucky and Southern Indiana; and six fetal echocardiography locations across Kentucky.
  • The American Board of Thoracic Surgery has certified the cardiothoracic surgeons at Norton Children’s Hospital with subspecialty certification in congenital heart surgery.
  • The Jennifer Lawrence Cardiac Intensive Care Unit is under construction to give our patients the most advanced cardiac intensive care unit available.
  • Our multidisciplinary approach to pediatric heart surgery brings together our specialists in cardiothoracic surgery, cardiology, anesthesiology, cardiac critical care and other areas to create a complete care plan tailored for your child.
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Norton Children’s Heart Institute

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