Aortic valve replacement with patient’s own pulmonary autograft is a good alternative for treatment of aortic valve disease in certain patients, especially if they’re young. Patients of the Jehovah’s Witness faith needing a Ross procedure still represent a dilemma for surgeons. We present a case of a young girl with aortic disease, who underwent a Ross procedure, without the use of any blood product.

A 9 years old girl presented to our institution with a diagnosis of double aortic lesion (severe insufficiency, moderate stenosis). She was of Jehovah’s Witness faith. Ross surgery was recommended earlier, but she was refused for treatment in other centers. After discussion with her parents, who confirmed that she should not be given blood, she was scheduled for Ross aortic root replacement. The only strategy used for blood conservation was treatment with recombinant human erythropoietin. At operation the patient’s own pulmonary valve was inverted onto the aortic root, and a 19 mm aortic homograft was implanted in the RVOT. No Fibrin glue or reinforced suture was used. Patient was sent home after 6 days in good conditions with a hemoglobin level of 9.4.

Ross procedure represents a challenging situation in a patient who refuses blood transfusion. This operation can be done safely. In our patient human erythropoietin was the only technique used for blood conservation. No cell-saving system or autotransfusion were used.