ABSTRACT
When the procedure was initially reported, it was associated with excessive mortality and morbidity. In addition, the surgical technique described was subcoronary implantation of the autograft into the native aortic root, which is considered technically demanding. Some felt it was turning a single valve disease into a double valve disease in the same patient. Hence the adoption rate of the Ross procedure was very low. However, when excellent long-term outcomes were demonstrated, the operation was met with renewed enthusiasm. The introduction of the full aortic root replacement technique, which made early outcomes more predictable than when the subcoronary technique was used, resulted in widespread popularity of the Ross procedure. It was then offered, perhaps unwisely, for almost all types of AV pathology and for a wide age range.
