Technical aspects of the Ross operation in children and adults

In 1967, Sir Donald Ross treated aortic stenosis with excision of the valve and replacement with the patient's own pulmonary valve. Since then, the Ross procedure has been applied to a variety of forms of aortic stenosis and left ventricular outflow tract disease. The procedure has undergone several modifications such as the root replacement method, inclusion cylinder technique, annular reduction and Konno root enlargement procedures. Advantages of the Ross procedure in children and young adults include freedom from anticoagulation, improved hemodynamic performance, decreased susceptibility to endocarditis and probable growth potential. This article reviews the technical aspects of the Ross procedure and its modifications, and their applicability in the surgical management of aortic stenosis and left ventricular outflow tract obstruction.