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Invited Commentary
October 2018

The Ross Operation Comes of Age

Author Affiliations
  • 1Imperial College, Harefield Heart Science Centre, Harefield Hospital, Harefield, London, England, United Kingdom
JAMA Cardiol. 2018;3(10):988. doi:10.1001/jamacardio.2018.2955

Approximately 50 years ago, I witnessed the birth of the Ross operation at the National Heart Hospital in London, United Kingdom, and began to watch it grow. There have been many so-called growing pains, but as is usual, these represent a passing phase. The origins of the operation stems from the hypotheses, advanced by Donald Ross, MB, ChB, FRCS, that a living valve substitute is essential for the valve’s long-term performance, the normal pulmonary valve shares many structural and functional characteristics with the normal aortic valve, and substitution had to be autologous to avoid rejection. These ideas were greeted by great skepticism. It has taken about 50 years to prove that Ross was right on all 3 accounts.1-4 Despite that, use of the Ross operation remained extremely low until very recently. This was thought by many experienced workers to be a lost opportunity.5

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