The Ross procedure, also known as pulmonary autograft, is a heart valve replacement operation to treat severe aortic valve disease, such as in children and young adults with a bicuspid aortic valve. It involves removing the diseased aortic valve, situated at the exit of the left side of the heart (where the aorta begins), and replacing it with the person's own healthy pulmonary valve (autograft), removed from the exit of the heart's right side (where the pulmonary artery begins). To reconstruct the right sided exit, a pulmonary valve from a cadaver (homograft), or a stentless xenograft, is used to replace the removed pulmonary valve. Compared to a mechanical valve replacement, it avoids the requirement for thinning the blood, has favourable blood flow dynamics, allows growth of the valve with growth of the child and has less risk of endocarditis. It is not performed in Marfan syndrome, if pulmonary valve disease, or if immune problems like lupus. Other contraindications include severe coronary artery disease and severe mitral valve disease. Due to a higher chance of dysfunction of the autograft, it may not always be safe to perform in rheumatic valve disease, or if a dysplastic dilated aortic root. Complications include endocarditis, degeneration of the valves, aortic dissection, haemorrhage and venous thromboembolism, among others. It risks having a disease of two valves instead of one. The procedure requires technical expertise. It can be performed using the traditional subcoronary method or more commonly the root replacement technique, which requires re-implanting the coronary arteries. After the operation, good blood pressure control prevents early dilatation of the new aortic root and allows the pulmonary autograft, now in the aortic position, to settle in its new environment. It may need reoperating on at a later date. Complications occur in 3 to 5% of cases, with early death rate almost negligible in very experienced centres. 80% to 90% of cases survive 10 years. As of 2014, the Ross procedure comprises less than 1% of all aortic valve replacements in North America. The procedure was first performed using the subcoronary method in 1967 by Donald Ross, for who the procedure is named for. The root replacement method was introduced in the early 1970s. It was continued and modified by others such as Magdi Yacoub, who used fresh valves from the explanted hearts of transplant recipients. Uses Several adaptations of the Ross procedure have evolved, but the principle is