The Ross procedure is a heart surgery used to replace a diseased aortic valve, sometimes using a patient’s own pulmonary valve. In adults with bicuspid aortic valves, surgeons can either “wrap” the transplanted valve to reinforce it or leave it unwrapped. This study followed 129 patients for over 10 years and compared the two approaches. Both groups had similar short-term outcomes, but patients with the wrapped valve were much less likely to experience valve failure or need another surgery. After 10 years, about 27% of unwrapped valves required reoperation, compared with only 4% of wrapped valves. These results suggest that wrapping the pulmonary valve during the Ross procedure stabilizes the aortic root and provides excellent long-term outcomes for adults with bicuspid valves.