Abstract
The Ross procedure provides excellent long-term survival, hemodynamics, freedom from valve-related complications, and quality of life. However, its usage has decreased mainly because of concerns with technical complexity and long-term durability. In the last 2 decades, the factors associated with late failure after the Ross procedure have been clearly identified. As a result, the surgical technique has been modified in order to address these issues, specifically aiming at stabilizing the autograft root at its different levels: annulus, sinus of Valsalva, and sinotubular junction; as well as mitigating the risk of pulmonary homograft dysfunction. We have implemented this systematic approach over the last decade with demonstrated safety and effectiveness. Furthermore, by breaking down the operation into its smaller steps, we believe it makes it highly reproducible in the hands of dedicated aortic reconstructive surgeons. This article details our step-by-step, systematic, and tailored approach to the Ross procedure in patients with aortic stenosis or regurgitation.
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