Operation

Operation: The Ross Procedure for Aortic Valve Disease

ISCOMS 2026 will feature an advanced congenital open-heart operation: the Ross procedure for aortic valve disease, performed by a dedicated team of congenital cardiac specialists at UMCG. The case is led by Dr. Ryan Accord, congenital cardiac surgeon, together with Dr. Maurits Zegel, fellow in congenital cardiac surgery, and colleagues including Dr. Valdo Cernac, congenital cardiac anaesthetist.

Nearly 60 years ago, Dr Donald Nixon Ross introduced a visionary surgical concept. After early experience with donor valve replacement, often limited by durability, he proposed something revolutionary: transplanting the patient’s own pulmonary valve into the aortic position. This pulmonary autograft created the possibility of a living valve substitute, offering outstanding haemodynamics, growth potential, and long-term performance beyond prosthetic alternatives.

Initially adopted with caution, the Ross procedure has evolved significantly. Over the past decades, technical refinements and standardised modifications have established it as a highly successful option for carefully selected young patients. Although surgically demanding, outcomes in expert hands have demonstrated major advantages, including freedom from lifelong anticoagulation, excellent long-term survival, and an exceptional quality of life.

In this year’s featured surgical video, we present a challenging re-operative case in a 27-year-old patient born with a bicuspid aortic valve. After early childhood surgery aimed at valve preservation, progressive deterioration resulted in severe aortic stenosis, left ventricular hypertrophy, and ascending aortic dilatation, frequently associated with congenital valve anomalies. Beyond the technical demands of a Ross procedure combined with ascending aortic replacement, this case highlights the importance of multidisciplinary evaluation and shared decision-making when tailoring lifelong valve solutions for young adults.

Join us for a rare surgical insight into one of cardiac surgery’s most fascinating and rewarding procedures.