Pediatric Ross Procedure

The Ross procedure is a complicated operation designed for people who need a new aortic valve. The heart has four valves, which keep blood flowing in one direction. The aortic valve sits between the left ventricle and the aorta. The left ventricle is the main pumping chamber of the heart and continually pumps oxygenated blood from the heart to the body. After the left ventricle squeezes and pumps blood into the body's blood vessels, the aortic valve functions to keep the ejected blood from going back into the left ventricle.

Problems with heart valves usually fall into one of two categories: the valve may leak (allow the back filling of blood into the ventricle) or it may be tight (not allowing blood to easily pass through in the correct direction). Either of these problems may cause the need for a new valve.

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Replacement heart valves traditionally come in two types:

Mechanical valves

• Made of metal, strong cloth and plastic.
• Function well and rarely wear out.
• Risks associated include blood clots which may form on the valve. Patients with mechanical valves have to be on an "anti-clotting" medication forever.

Biological valves

• Made from animal or human cadaver tissue.
• Work well and do not require anti-clotting medication.
• Risks associated include valve breakdown, causing it to be replaced, generally after 10-15 years.

The Ross procedure is an aortic valve replacement in which the patient's pulmonary valve - the valve between the right ventricle and the pulmonary artery which goes to the lungs - is removed and placed where the aortic valve usually sits. The demands of the valve in the pulmonary position are much less than in the aortic position, since the pressures on the right side of the heart are much less than on the left side.

The patient's pulmonary valve (now in the aortic position) may last a lifetime. No anti-clotting medication is needed. Another advantage of the Ross procedure in children is that the pulmonary valve will grow in the aortic position and an oversized new pulmonary valve may be placed. In other words, it decreases the number of times children will need another operation to replace a valve which has become too small.

The Ross procedure can be a wonderful alternative for young people who need a new aortic valve, without a lifetime of anti-clotting medication.

Risks associated with the Ross procedure include:

• New valve(s) may fail - odds of needing a replacement valve are roughly 20% over 10 years
• Ross procedure is a larger, more extensive operation with more chance for complications

The decision whether the Ross procedure or a conventional valve replacement is the better option depends on the patient's individual circumstance and should be discussed fully with the family, patient, and physicians.

At Children’s Heart Institute at Children’s Memorial Hermann Hospital, patients with congenital or acquired heart disorders receive hands-on specialized care 24/7 from a team of affiliated physicians and specialty-trained nurses who aim to deliver the best possible outcomes.

Children’s Memorial Hermann Hospital was named one of the top children's hospitals nationally in Cardiology & Heart Surgery by U.S. News & World Report. In addition, Children’s Heart Institute is among the top congenital heart surgery programs in North America for patient care and outcomes, according to the Fall 2019 Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database Report of 118 STS participating programs.

In collaboration with various subspecialties, the affiliated team provides comprehensive care for newborns, children and adolescents, with the ability to transition into adult congenital cardiac care. Team members have the experience and skills necessary to offer innovative treatment methods and specialized services, including, but not limited to:

• Biventricular repairs and biventricular conversions
• Congenital heart optimization
• Full repairs for complex congenital heart defects in newborns
• Hybrid catheterization and surgical procedures
• Minimally invasive transcatheter pulmonary valve (TPV) therapy
• Minimally invasive repairs
• Treatment for adult congenital heart disease
• Valve repairs and preservation

With the Level IV Neonatal Intensive Care Unit (NICU) and a dedicated Children’s Heart Institute Intensive Care Unit at Children’s Memorial Hermann Hospital, critical heart patients have access to quality, specialized care. By utilizing state-of-the-art techniques, the team at Children’s Heart Institute strives to offer patients with the most complex problems the greatest opportunity for a normal life.

If you have any questions, use the online tool below to help us connect with you. To refer a patient or schedule an appointment, please contact our clinic using the information below.

• Pediatric Cardiology Clinic
  The University of Texas Health Science Center Professional Building
  6410 Fannin, Suite 370
  Houston, TX 77030
  Phone: (713) 486-6755 (Appointment Line)
   
• Pediatric and Congenital Heart Surgery Clinic
  The University of Texas Health Science Center Professional Building
  6410 Fannin, Suite 370
  Houston, TX 77030
  Phone: (713) 500-5746
  CMHH-Heart@memorialhermann.org

The Children’s Heart Institute is a collaboration between the affiliated physicians at McGovern Medical School at UTHealth Houston and Children’s Memorial Hermann Hospital. Typically, patients are seen on an outpatient basis at a UT Physicians clinic with all inpatient procedures performed at Children’s Memorial Hermann Hospital.