In the heart there are 4 valves which act as one way doors for the flow of blood through the heart and to the rest of the body. These valves may be abnormal from birth and because of this, tend to deteriorate with time. Valves may also fail because of injury, infection, illness like rheumatic or scarlet fever and aging with calcium deposition. These valves may become thickened and stiff resulting in stenosis or they may close incompletely and leak resulting in insufficiency. The most commonly affected valves are the aortic, mitral and tricuspid valves.

Previously, valves were replaced with either a mechanical or a tissue (porcine) valve. The decision regarding the type of valve used is based on the patients age, sex, heart rhythm and ultimate ability to tolerate anticoagulation (blood thinning). Newer procedures for valve surgery utilize the patient's own valve either repaired or transferred or the use of frozen valves from human donors. Repair techniques are not applicable to the mitral and tricuspid valves and work best when insufficiency is the presenting problem. After repair, long term anticoagulation is not needed and the incidence of neurologic events, i.e. transient ischemic attacks or strokes is much less likely than following valve replacement especially mitral valve replacement. The Ross procedure is one such technique. Transfer techniques, including the Ross procedure, during which your own pulmonary valve is transferred to the aortic position, replace the badly diseased aortic valve with a frozen valve. This operation allows excellent valve function and does not require long term anticoagulation. It is also associated with much fewer neurologic events when compared to mechanical valve replacement. This operation is most indicated in a patient with only aortic valve disease and less than 50 years of age.