Ross Procedure at the Crossroads

The quest for a perfect heart valve substitute has beengoing on for half a century. In 1960, Lower et al1 described the feasibility of replacing the aortic valve of dogs with the native pulmonary valve. In 1967, Ross performed this procedure in humans.2 Ross transferred the pulmonary valve into the aortic root with the same tech-nique used to implant aortic valve homograft3 (ie, the pulmonary sinuses of the pulmonary root were partially excised, and the pulmonary valve was secured in the recipient’s aortic root with 2 suture lines, 1 below and 1 above the aortic annulus, leaving the coronary artery orifices unobstructed). Although many surgeons gained experience with this type of aortic valve replacement using an aortic valve homograft, the Ross procedure did not gain widespread popularity until the late 1980s when the technique of aortic root replacement was described for thi