Innovative Valve Replacement Surgery Offers Significant Benefits for Teens and Young Adults Born with Heart Defects

When Supritha Nanjundaswany of Mason, Ohio was ready to start a family, she wasn’t going to let a heart condition get in the way. A supported Ross procedure at Cincinnati Children’s Adult Congenital Heart Disease (ACHD) Program to replace a faulty aortic valve helped her get the care she needed without compromising her dream of a future pregnancy.

Understanding the Ross Procedure

Cincinnati Children’s is one of a few pioneering children’s hospitals in the United States that has developed the supported Ross procedure as an option for heart valve replacement surgery. This innovative approach offers significant advantages for teens, young adults and women of childbearing age born with heart defects who need aortic valve replacement surgery to correct the issue.

Benefits of the Ross procedure include:

  • A decreased need for blood thinners or anticoagulation medication.
  • Improved safety and fewer complications during pregnancy because risk from anticoagulation medication has been eliminated.
  • Less deterioration of the replacement valve over time.
  • More precise fit of the replacement valve with less chance of rejection.
  • Improved long term survival over other valve replacement options.

There are two kinds of Ross procedures: traditional and supported. During a traditional Ross, the surgeon removes the patient’s damaged aortic valve and replaces it with the patient’s healthy pulmonary valve. This is called an autograft. A donor valve then takes the place of the pulmonary valve.

In a supported Ross procedure, the autograft is placed inside a graft or jacket made of materials your body tolerates easily. The outer graft “supports” the autograft and prevents it from expanding or leaking over time.

"It's kind of like a cocoon," says David Lehenbauer, MD, cardiothoracic surgeon at Cincinnati Children’s Heart Institute. "It wraps around the autograft so that it doesn't dilate and it doesn't leak. It's a very durable, long-lasting repair. We've had outstanding outcomes with the supported Ross procedure at Cincinnati Children's, and we are strong advocates of that approach."

A Game Changer

With other types of valve replacement surgery, lifelong blood thinners are required. Blood thinners often cause complications of excessive bleeding and during pregnancy can cause miscarriage or stillbirth. Some blood thinners, like Coumadin (or warfarin) also increase the probability of several birth defects.

But with the supported Ross procedure, because the pulmonary valve is made from the patient’s own tissues, it doesn’t cause blood clots or damage to the patient’s blood cells. This means blood thinning medication is not necessary. For younger patients, or women such as Supritha, 32, who may want to become pregnant, that can be a game changer.

“If there’s a long-term solution for patients that allows them to avoid anticoagulation, that’s desirable – especially for young people who have decades and decades ahead of them,” says Nicole Brown, MD, a cardiologist with Cincinnati Children's ACHD Program.

“Most of the time, when we do a supported Ross procedure, it's to give our patients a result that's as normal as possible but does not involve the need for a mechanical valve or anticoagulation with blood thinners. For Supritha, it was an ideal solution,” says Dr. Brown.

The ACHD Program offers the gold standard of care for adults born with heart defects and is one of the first in the nation to be recognized as an ACHA-accredited Comprehensive Care Center. The team of heart specialists at Cincinnati Children’s includes internationally renowned cardiologists and surgeons, as well as dedicated and knowledgeable nurses and support staff, who understand the unique physiology of congenital heart defects. Together they offer comprehensive cardiac care that includes lifelong monitoring for patients with complex heart conditions.

The Right Choice

"Since I wanted to become pregnant, Dr. Brown suggested a supported Ross procedure instead of a tissue valve replacement," says Supritha. "I researched the heart surgeons at Cincinnati Children's and spoke with many nurses. That gave me the confidence I was making the right choice."

Supritha’s valve replacement surgery took place in October 2021. Although it was major surgery, she says the experience was a positive one.

“For one or two days I had some fatigue. But from the third day after my surgery, I started to walk. Within 15 to 20 days, I got my strength back. After 20 days, I started doing work around the house and cooking again. I went to cardiac rehab three days a week for two months. Now I go to the gym. Once I'm six months past my surgery, I should be able to get pregnant safely,” says Supritha.

"All the nurses, doctors—everyone at Cincinnati Children’s—took care of me very well,” she adds. “Because of their support, I’m one step closer to my dream of having a child.”

(Published May 2022)