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.