In long term followup studies, the autotransplanted valve is never obstructive or stenotic. Some mechanical or tissue valves are not large enough for the recipient, resulting in stenosis. This has not been a problem with the Ross procedure. The pulmonary valve provides the appropriately sized, naturally designed replacement for the diseased aortic valve. The hemodynamic performance of the autotransplant is ideal, with no measurable gradients across the aortic outflow tract after completion of the repair.
Autografts are always sterile, non-antigenic, and are created with the perfect design.
They are functionally, structurally, and histologically nearly identical to the aortic valve. Use of the root replacement technique provides complete transposition of the entire sinotubular mechanism, preserving the size and orientation of the entire valve closure mechanism, reducing complications, and making the surgical techniques easier and more reproducible. A women of child bearing age with aortic valve disease represents a special challenge. Any valve substitute chosen for a female patient within those age ranges must be durable enough to provide many decades of uninterrupted performance. Thus any heart valve replacement in a woman of child bearing years must permit her to exist safely without the burden of anticoagulation.