Relevance: Over decades, there’s been debate about which procedure is better between ROSS and AVR.

Purpose and Material: To prove which of the 2 procedures is clinically more efficient in patients aged less than 60years, using European Society of cardiology, American heart association, their respective journals and researches.

Method: Literature review of the clinical importance of each procedure based on indication, contraindications, advantages, disadvantages, post-operative management, post-operation complication, 20 year mortality rate and valve related death.

Results

Indication: ROSS: patients with normal aortic annulus. AVR: patient without contraindication to oral anticoagulants .Contraindication: ROSS: pulmonary valve pathology. AVR: stroke, bleeding disorders and organ failure. Advantage: ROSS: reduces risk of stroke and bleeding. AVR: decrease need for re-intervention. Disadvantage: ROSS: antibiotics for procedures with risk of bacteremia. AVR: absence of adequate valve size in children. Post-operative management: ROSS: 5-9 days inpatient care, full recovery by 3 months. AVR: 7-12 day’s inpatient and cardiac rehabilitation. Post-operative complication: ROSS: aortic regurgitation, Right ventricular obstruction, pulmonary allograft stenosis, aortic aneurysm. AVR: prosthetic dysfunction, endocarditis, thrombosed valve, thromboembolism, intravascular hemolysis, patient prosthetic mismatch. 20year mortality rate Mortality rate: ROSS: 29.9%. AVR: 72.3%. Valve related death: ROSS Procedure 25%. AVR: 57%.

Conclusion: ROSS is clinically more effective in patients aged less than 60years but requires great surgical skills and precision.