The Ross Procedure is "the third way" to fix a calcified aortic valve - an option rarely mentioned by mainstream surgeons becuase only few master it.
Only around 15-20 have experience enough to perform it with success. Also, it's the most expensive of the three options for aorta valve surgery.
As a valve patient you’re often presented with a simple choice between a biological and a mechanical heart valve (with their respective well-known downsides, see the chart).
However, the Ross Procedure may be a rather superior alternative for you, if you're an otherwise healthy patient younger than 60.
There are very few commercial interests to promote this attractive alternative (and your average surgeon can't make it). But if you fulfil the criteria, it's superior.
Ross became my personal first choice in May 2018 when I had my surgery at Mount Sinai Hospital in New York City. And it may also be attractive for you too.
The information on this site was gathered before my own surgery in May 2018.
The data I've seen since have only been greater - showing that this indeed a very interesting alternative. The only downside is the price tag - it's expensive.
Writing this I'm now six years down the road after the surgery and have never felt better. No medicine, no side effects, no restraints on lifestyle or otherwise. I'm so happy I went for Ross Procedure.
My name is Rune (left) together with my surgeor, Professor Paul Stelzer (right).
I'm a journalist and entrepreneur in Copenhagen, and a heart valve patient.
When I was diagnosed in 2009 with a birth defect, bicuspid calcified aortic valve. I trawled through every piece of information and evidence I could find before making up my mind about procedure, taking place in 2018.
Having read a lot, I was in no doubt that the Ross Procedure was the silver bullet for me.
I've made this article about this often overlooked but superior procedure in order to help others understand it.
Also to help find the few skilled surgeons who have perfected this procedure invented by the renowned British Professor and surgeon Donald Ross.
Personally I went for professor Paul Stelzer at Mount Sinai Hospital in NYC and couldn't have been happier. He was not just great but outstanding.
Below is my personal lay-man's comparison chart based on extracting data from counless of studies of the outcomes of the three main methodes for aorta valve surgery, Yu could call it a primitive "meta study" of the main studies in this field. I presented this to several cardiologists and surgeons at the time, and the generally nodded to how they also see it - and the pros and cons. The data is how it looked early 2018:
Download comparison chart as a PDF: Ross_Procedure_Comparison_Chart.pdf
It took me a long time to find all these data in numerous studies, and it shows a remarkable result: Ross Procedure is a superior procedure in many cases. Initially I didn't know about the procedure as it's very rare to find a hospital doing it - due to cost and complexity.
My cardiologist at my local hospital routinely offered me a mechanical valve - as is standard guideline procedure for "a young man" (below 60 in the medical world) because most hospitals don't offer the highly specialised Ross Procedure.
Most cardiologists and surgeons I spoke to said privately that between the two conventional procedures they would choose a biological tissue valve for themseles any day to avoid blood thinners. That interesting view (contrary to the official guidelines) made me begin researching. Thoroughly.
Soon I found out that there actually was a third way no one mentioned, the Ross Procedure. Comparing numerous studies I compiled the above Ross Procedure comparison chart of pros and cons - which I used to make up my own mind.
Remember that there a literaly no commercial interests to pay for marketing for Ross Procedure in the same way as for the two other methods (medtech industry valve producers). Ross is done with a human donor valve and thus there are only very few players to sponsor information, even if the outcomes data show that it's great for specific types of patients (i.e. the younger and otherwise healthier).
So which surgeon to choose for a Ross Procedure to fix your calcified aorta valve? In May 2018 went for professor Paul Stelzer in New York, one of the world's best, and give him my warmest recommendations.
My recommendation is not to go with a surgeon with less than 150 Ross procedures on the clock. Since this is a complex operation, and it takes a lot of practice.
I ended up selecting Professor Paul Stelzer from Mount Sinai Hospital in New York. I was his Ross patient number 649, and having done more than 6000 open heart surgeries he is one of the most respected and admired heart surgeons in the world.
Apart from being a unique person with unrivalled bedside manners he has published numerous studies into the long term effects of Ross. Meeting Paul Stelzer and being treated be him was an incredible experience from beginning to end. I can not recommend him enough. You can reach him at Paul.Stelzer@mountsinai.org
If you want to find a experienced Ross surgeon in other contries, I have come across these top Ross surgeons with more than 150 procedures on the clock and an impeccable reputation:
USA:
- Professor Paul Stelzer, Mount Sinai Hospital, NYC: Paul.Stelzer@mountsinai.org
GERMANY:
- Professor Hans Joachim Schäfers, University Hospital of Homburg: h-j.schaefers@uks.eu
- Dr. Armin Gorski, University Hospital of Würzburg: Gorski_A@ukw.de
- Professor Wolfgang Hemmer, Sana Herzchirurg, Stuttgart: Wolfgang.Hemmer@Sana.de
AUSTRALIA:
- Professor Peter Skillington, Melbourne: inquiries@vcscardiology.com.au
CANADA:
- Professor Tirone David, UHN Toronto: Tirone.David@uhn.ca
- Professor Ismail El-Hamamsy, Montreal Heart Institute: +1.514.376.3330 (3715)
If you are a Ross surgeon with more than 150 procedures behind you, and you would like to get on the list, please write to me.
I frequently get emails with questions from future patients considering having a Ross Procedure done. This time from a German patient, who prefers to be anonymous. He has however, accepted that his questions and my answers are published here so others can read it.
Questions about Ross Procedure from a German patient NN
QUESTION SUMMARY:
"Thank you very much for your activity to put up the great page with so important informations and facts about the Ross Operation. These information I have seen nowhere before.
I think I am in the nearly same situation before your operation with a bicuspid calcified aortic valve and I am xx years old.
But the decision is not so easy to go outside the mainstream an go the third way (against an biological). With modifying two valves and an higher difficult operation. And the benefits you show are not well known and not often published.
My additional interest to thank you is to know if you have symptoms before operation. In my situation I will just become tired very quickly an feel dizziness. My stenosis is starting high grade. Therefore it is difficult to find out the right time.
Perhaps you would say if this is also your former situation. But of course you must not.
I would be glad if you would give me a short Feedback.
Best wishes and greetings.
NN"
ANSWER:
"Dear NN,
thank you for your email and the kind words.
I had my surgery on May 9th 2018, and I could not be happier. It’s an ingenious method (for some patients). The best of all worlds, in my mind if you fulfil the criteria.
And the numbers (see my comparison chart on the site) speak for themselves. They are all based on studies. I spent many months reading A LOT of studies in this field and had the chart verified by several experts, among them some of the doctors mentioned in my article.
There are several reasons why the Ross Procedure is not more known:
1) There are no commercial interests to back up propaganda (like the valve producers for the two other procedures).
2) Normal heart surgeons can’t do this procedure, it's only real experts, why most surgeons will not talk about it - because they can not offer it - and often do not know much about it.
3) It’s pretty expensive, making it the choice of the few who can afford it.
4) Donor valves are in short supply, especially in Europe.
I visited three doctors in Germany personally - liked them all (very much, and could have taken any of them) but decided for Professor Paul Stelzer for my heart valve surgery in NYC in the end.
Why?
a) He has done more than 650 Ross Procedures and is one of the most experienced in the field.
b) The donor valves in the states are stripped of DNA and RNA (thanks to a company called Cryolife), and there are greater choice of valves than in Europe, where they will often "have to take what they can get".
But the US surgery is much more expensive, like factor 4-5, and you can not (easily) insure the risk of something going wrong.
Additionally you will have to stay in the US for at least 4-5 weeks post surgery before flying transatlantic. Also the cost of flights and for staying (for family too) is a substantial cost.
With regards to timing, I would definitely do it within the next few months if you are beginning to experience fainting/dizziness. Then it’s time. I don’t know your numbers, but when there are symptoms it’s almost certainly time.
Sometimes even if you do not have symptoms it’s a good idea to get it done - before the heart is harmed by the pressure.
Finally make sure you have the size of your ascending aorta measured.
It’s stupid not to fix it at the same time, if it has grown too big,
I was a borderline case with a measurement of 45mm, but I had mine plicated (narrowed).
I gave the surgeon a free choice whether he wanted to narrow it (like a pair of trousers legs) or replace it with a plastic pipe.
It all depends in the quality of your ascending aorta and they don’t know until they open and look and feel.
Good luck with your surgery."
Do you have any questions or comments, please do get in touch.