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. Aftercare includes regular echocardiography and lifelong endocarditis prophylaxis. Epidemiology Complications occur in 3% to 5% of cases with one to 3% chance of early death. The death rate is almost negligible in very experienced centres. 80% to 90% of cases survive 10 years, and 70% to 80% may live up to 20 years. As of 2014, the Ross procedure comprises less than 1% of all aortic valve replacements in North America. History Replacing a diseased aortic valve with an aortic valve from a cadaver was first performed by Donald Ross in England in June 1962, and shortly after in July 1962 by Brian Barratt-Boyes in Auckland, New Zealand. In 1967 Ross took the normal pulmonary valve of a person with severe aortic valve disease, and placed it in the aortic position where the diseased aortic valve was removed. To reconstruct the missing pulmonary outflow tract, a homograft stored and sterilised from a cadaver was used to replace the removed pulmonary valve. In 1972, Ross introduced the technique using the root replacement method. For 30 years he was almost the only surgeon performing the procedure, until it gained popularity. Marian Ionescu in Leeds, in an attempt to seek other materials, unsuccessfully tried fascia lata from the person's own thigh to create a living valve. He then tried successfully with cattle pericardium fixed with glutaraldehyde, and the procedure became widespread before then falling out of favour as they failed. Then came pig valves (xenograft) before the 1980s trend for mechanical valves. The Ross procedure was continued and modified by Magdi Yacoub, who used fresh valves from the explanted hearts of transplant recipients. Etymology It has also been called the double-switch Ross procedure. Society In 1997, to replace a bicuspid aortic valve, the Ross procedure was performed on Arnold Schwarzenegger. The procedure was more popular in the 1990s and then declined in use over the subsequent 20 years. Data relating to the procedure is held in the Ross registry. Other animals The procedure has been carried out in pigs and sheep for the purpose of research. Footnotes References Further reading External links Cardiac surgery Valvular heart disease