Ross Procedure Age Selection — EECC MCQ

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EasyValvular Heart DiseaseRoss Procedure Age SelectionEECC

A 70-year-old man with severe aortic stenosis asks about the Ross procedure. His surgeon explains that at age 70, a bioprosthetic AVR or TAVI would be more appropriate. What is the upper age limit for the Ross procedure?

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Correct answer: B — The Ross procedure is generally recommended for younger patients (<50-55 years) who wish to avoid anticoagulation and want an active lifestyle; it is not recommended for elderly patients due to the complexity of a double-valve operation and limited life expectancy to justify the surgical investment

The Ross procedure (autograft pulmonary valve to aortic position, pulmonary homograft to pulmonary position) is a complex double-valve operation best suited for: (1) young patients (<50-55 years) who benefit most from: avoiding lifelong anticoagulation (unlike mechanical valve), excellent haemodynamics, living tissue with growth potential, and low thrombogenicity; (2) women planning pregnancy (avoids anticoagulation); (3) active individuals. It is NOT recommended for elderly patients because: (1) limited additional life expectancy does not justify the higher operative complexity; (2) bioprosthetic valves (surgical or TAVI) provide adequate durability for the expected lifespan; (3) the Ross procedure has a learning curve and should be performed at high-volume centres (>15-20/year). The 2025 ESC VHD Guidelines position the Ross procedure as an option for young adults requiring AVR.

Reference: ESC/EACTS (2025): VHD Guidelines