EACTS Expert Consensus Statement on the Ross Procedure in Adult Patients

The Ross procedure, which involves replacing a diseased aortic valve with the patient's own pulmonary valve (pulmonary autograft), has gained renewed attention in adult patients due to mounting evidence of excellent long-term outcomes. With increasing data demonstrating restoration of life expectancy and improved valve-related outcomes, it is now considered a viable first-line option for selected young and middle-aged adults with non-repairable aortic valve disease. Nonetheless, its adoption remains inconsistent across institutions, partly due to concerns about surgical complexity, long-term durability, and the need for structured follow-up. This expert consensus document, commissioned by the European Association for Cardio-Thoracic Surgery, synthesizes the current evidence and offers clinical statements for using the Ross procedure in adults. Developed through a systematic review and informed by the collective experience of a multidisciplinary panel of internationally recognized experts, the document addresses key topics including patient selection, technical refinements, and perioperative management. Emphasis is also placed on the need for procedural standardization, high-volume surgical expertise, and longitudinal imaging-based follow-up. Moreover, comparative outcome data and subgroup considerations are critically appraised, and areas for future investigation are outlined. This clinical practice document is intended to assist clinicians and Heart Teams in making informed treatment decisions, support harmonized implementation across centres, provide technical considerations to optimize procedural success, and substantially improve outcomes for patients considered for this complex but promising procedure.

Authors

Institutions

Publication Details

Journal
European Journal of Cardio-Thoracic Surgery
Published
2025-10-03
DOI
https://doi.org/10.1093/ejcts/ezaf295
Citations
3
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
Field-Weighted Citation Impact
4.16
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

EACTS Expert Consensus Statement on the Ross Procedure in Adult Patients

Nikolaos Bonaros, Rafael Sádaba, Joseph E. Bavaria, Ruggero De Paulis et al.
3 citations
European Journal of Cardio-Thoracic Surgery
Cardiac Valve Diseases and Treatments
4.16
article

EACTS Expert Consensus Statement on the Ross Procedure in Adult Patients

Nikolaos Bonaros, Rafael Sádaba, Joseph E. Bavaria, Ruggero De Paulis, Peter Skillington, Leonardo Mulinari, Tomáš Holubec, Marjan Jahangiri, Filip Casselman, Alfred Kocher, Peter Verbrugghe, Jordan P. Bloom, Roman Gottardi, Emmanuel Lansac, Johanna J.M. Takkenberg, Martin Andreas, Matthias Siepe, Laurent de Kerchove, Ján Gofus, Denis Berdajs, Milan Milojevic, Evaldas Girdauskas, Jan Vojáček, Ismaı̈l El-Hamamsy, Maral Ouzonian
article en
3 citations

Abstract

The Ross procedure, which involves replacing a diseased aortic valve with the patient's own pulmonary valve (pulmonary autograft), has gained renewed attention in adult patients due to mounting evidence of excellent long-term outcomes. With increasing data demonstrating restoration of life expectancy and improved valve-related outcomes, it is now considered a viable first-line option for selected young and middle-aged adults with non-repairable aortic valve disease. Nonetheless, its adoption remains inconsistent across institutions, partly due to concerns about surgical complexity, long-term durability, and the need for structured follow-up. This expert consensus document, commissioned by the European Association for Cardio-Thoracic Surgery, synthesizes the current evidence and offers clinical statements for using the Ross procedure in adults. Developed through a systematic review and informed by the collective experience of a multidisciplinary panel of internationally recognized experts, the document addresses key topics including patient selection, technical refinements, and perioperative management. Emphasis is also placed on the need for procedural standardization, high-volume surgical expertise, and longitudinal imaging-based follow-up. Moreover, comparative outcome data and subgroup considerations are critically appraised, and areas for future investigation are outlined. This clinical practice document is intended to assist clinicians and Heart Teams in making informed treatment decisions, support harmonized implementation across centres, provide technical considerations to optimize procedural success, and substantially improve outcomes for patients considered for this complex but promising procedure.

European Journal of Cardio-Thoracic SurgeryVol. 68(2)
Goethe University Frankfurt (DE), Cliniques Universitaires Saint-Luc (BE), University Health Network (CA), University of Miami (US), Thomas Jefferson University (US), Medical University of Graz (AT), Charles University (CZ), Epworth Hospital (AU), Universitair Ziekenhuis Leuven (BE), Erasmus MC (NL), University Hospital of Basel (CH), University Hospital of Zurich (CH), Onze Lieve Vrouwziekenhuis Hospital (BE), Mount Sinai Hospital (US), Institute for Cardiovascular Diseases of Vojvodina (RS), University of Miami Hospital (US), University Hospital Frankfurt (DE), University Hospital Hradec Králové (CZ), San Diego Cardiac Center (US), Foundation of Cardiac Surgery Development (PL), Erasmus University Rotterdam (NL), KU Leuven (BE)
Openalex Percentile: Top 5%
Cardiac Valve Diseases and Treatments
4.16
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.