Post-Ross Procedure Follow-Up Guidelines

Introduction to Follow-Up

Patients who have undergone the Ross procedure require regular, lifelong cardiology follow-up with specific monitoring of both the autograft and pulmonary homograft function to ensure optimal outcomes and early detection of complications, as recommended by the European Society of Cardiology 1, 2

The first post-operative visit should occur within 6 weeks of discharge if no inpatient rehabilitation was completed, and within 12 weeks if rehabilitation was completed, according to the European Heart Journal guidelines 1
All patients should receive lifelong cardiology follow-up at a cardiac center, with yearly follow-up recommended for patients who have undergone the Ross procedure, as suggested by the European Society of Cardiology and the American Heart Association 1, 2, 3

Baseline clinical assessment should include symptom status, physical examination with focus on cardiac auscultation, heart rhythm and ECG abnormalities, chest X-ray, echocardiography to assess pericardial effusion, ventricular function, autograft function, and pulmonary homograft function, and laboratory tests including hematology, biochemistry, and tests for hemolysis, as recommended by the European Society of Cardiology 1

Monitor for autograft dilatation and assess for progressive aortic regurgitation, as well as monitor for right-sided pulmonary homograft obstruction and/or regurgitation, according to the European Society of Cardiology guidelines 1, 2

Echocardiography should be performed at each follow-up visit to assess autograft function and dimensions, pulmonary homograft function, and ventricular size and function, as recommended by the European Society of Cardiology and the American Heart Association 1, 2, 3

Endocarditis prophylaxis is recommended in all cases, as suggested by the European Society of Cardiology 2
High-level activity is possible in uncomplicated cases with good LV function, but contact sports are contraindicated in patients on anticoagulants, according to the European Society of Cardiology guidelines 2
Women with BAV and ascending aorta diameter >4.5 cm should be counseled about high risks of pregnancy, as recommended by the American Heart Association 3

Anticoagulants may cause embryopathy if mechanical valves are used in reoperations, and patients should be counseled about the risks, as suggested by the European Society of Cardiology 2