The ideal aortic valve substitute in non-elderly adults requires a tailored approach and thoughtful consideration. The main principles remain however constant, seeking to optimize long-term survival and quality of life, while limiting the risks of valve-related complications and reinterventions. In recent years, considerable data has emerged focusing on long-term outcomes after aortic valve surgery in non-elderly adults. As such, the Ross procedure has gained renewed interest because it results in several clinically relevant advantages when compared with other valves substitutes. However, the Ross procedure is a more complex operation and involves two valves instead of one. In this review article, we will examine the theoretical and clinical rationale for the Ross procedure, optimal patient selection, and give an overview of technical details and patient management. Finally, we will present the broader clinical implications regarding the management of aortic valve disease in non-elderly adults in 2020.