{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:51:54Z","timestamp":1792032714998,"version":"4.4.0"},"reference-count":61,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T00:00:00Z","timestamp":1705881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The Ross procedure is gaining recognition as a significant option for aortic valve replacement (AVR), and is particularly beneficial in specific patient groups. Although categorized as a class IIb recommendation in the 2020 American College of Cardiology (ACC)\/American Heart Association (AHA), and the European Society of Cardiology (ESC) management guidelines on valvular heart disease, recent studies bolster its credibility. Research, including a propensity-matched study, underlines the Ross procedure\u2019s association with enhanced long-term survival and reduced adverse valve-related events compared to other AVR types. This positions the Ross procedure as a primary option for AVR in young and middle-aged adults within specialized centers, and potentially the only choice for children and infants requiring AVR. This review meticulously examines the Ross procedure, covering historical perspectives, surgical techniques, imaging, and outcomes, including hemodynamic performance and quality of life, especially focusing on pediatric and young adult patients. It explores contemporary techniques and innovations like minimally invasive approaches and tissue engineering, underscoring ongoing research and future directions. A summarization of comparative studies and meta-analyses reiterates the Ross procedure\u2019s superior long-term outcomes, valve durability, and preservation of the left ventricular function, accentuating the crucial role of patient selection and risk stratification, and pinpointing areas for future research.<\/jats:p>","DOI":"10.3390\/jcm13020630","type":"journal-article","created":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T11:36:41Z","timestamp":1705923401000},"page":"630","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The Ross Procedure: Imaging, Outcomes and Future Directions in Aortic Valve Replacement"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9682-3815","authenticated-orcid":false,"given":"Domenico","family":"Galzerano","sequence":"first","affiliation":[{"name":"Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia"},{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6914-0730","authenticated-orcid":false,"given":"Naji","family":"Kholaif","sequence":"additional","affiliation":[{"name":"Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia"},{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bandar","family":"Al Amro","sequence":"additional","affiliation":[{"name":"Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia"},{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Al Admawi","sequence":"additional","affiliation":[{"name":"Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6362-4553","authenticated-orcid":false,"given":"Abdalla","family":"Eltayeb","sequence":"additional","affiliation":[{"name":"Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0305-0113","authenticated-orcid":false,"given":"Giovanni","family":"Di Salvo","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Medical School, University of Padua, 35122 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0752-4574","authenticated-orcid":false,"given":"Zohair Y.","family":"Al-Halees","sequence":"additional","affiliation":[{"name":"Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1161\/CIRCULATIONAHA.107.726349","article-title":"The Ross procedure: A systematic review and meta-analysis","volume":"119","author":"Takkenberg","year":"2009","journal-title":"Circulation"},{"key":"ref_2","first-page":"413","article-title":"Valve performance classification in 630 subcoronary Ross patients over 22 years","volume":"144","author":"Ercan","year":"2012","journal-title":"J. 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