Indications for the Ross operation in children and adults

The Ross operation is a technically challenging procedure due to its inherent difficulties and crucial need for attention to detail. Establishment of a systematic approach to the procedure, in addition to an overall improvement in surgical technique, has led to favorable outcomes. These successful outcomes have created a resurgence in interest in this procedure, thus providing an alternative approach to patients who may have otherwise required placement of a mechanical valve, requiring lifelong anticoagulation that might have had an adverse affect on their quality of life. The increasing acceptance of this procedure led to expansion of inclusion criteria for subjects suitable for this procedure. At present, indications to perform the Ross procedure include patients with single valve pathology, mechanical or homograft failure, endocarditis, rheumatic valvular disease, and congenital critical aortic valve stenosis. Over the years, the absolute contraindications have remained the same and include multi-vessel coronary artery disease, primary pulmonary valve disease or pulmonary valve disease that exists due to an underlying connective tissue disorder. The purpose of this article is to summarize the current indications, contraindications and newer modifications of the Ross procedure.