Ross Procedure: What 4 Questions Should Patients Ask Before Surgery?

When younger patients with aortic valve disease reach the point they need some type of intervention to repair or replace their valve, one of the most consequential decisions they will make is what kind of surgery to have. A Ross Procedure is an advanced surgical option for younger patients that involves removing the diseased aortic valve and replacing it with the patient’s own pulmonary valve. A donor valve is then implanted in the pulmonary valve’s position.  Because of its complexity, patients should understand the intricacies, advantages, and possible limitations before choosing the Ross Procedure.

Adam Pick, founder of HeartValveSurgery.com, is a Ross Procedure recipient. While he’s thankful to be twenty years post-surgery without the need for reoperation, he understands how important it is that patients are mindful of whether the Ross Procedure is right for them. Adam believes one of the best ways to do that is to ask the right questions. Adam recently met with Dr. Eric Roselli, the Chief of Adult Cardiac Surgery at the Cleveland Clinic, and a world-renowned aortic valve expert, to discuss four important questions patients should ask before a Ross Procedure.

What Patients Need to Know About the Ross Procedure

Here are the key insights shared by Dr. Roselli:

• Younger patients and valve choice. Dr. Roselli explained that younger patients need to understand that their goals are part of a shared decision-making process. “I think the first thing a patient should ask is whether they should go with a biologic or mechanical valve, and both are really good. I think that guides the first part of the decision-making. Patients need to know how they feel about anticoagulation and have that discussion with their surgeon. If they want to avoid anticoagulation, that opens a discussion about the biologic choices, which is where the Ross operation fits in.”

Dr. Eric Roselli

• Patients should consider whether they are a good candidate for a Ross Procedure. Dr. Roselli said, “I know there are a lot of centers building their Ross programs. It’s kind of awesome that we’ve seen a resurgence of it. And Adam, you’re a living example of a wonderful choice made. But I worry a little bit that there may be too much excitement about it because you shouldn’t feel like you’re guaranteed that this living valve choice will absolutely last you a lifetime. That’s concerning to me. In fact, that’s concerning to me when someone chooses a mechanical valve as well, because sometimes you’ll need an operation later in life. When you’re a young patient, we’re looking at decades of survival after your surgery. The way I generally think about a Ross Procedure is it is a great option for younger patients who want to avoid anticoagulation, and maybe it will give them one less operation in their lifetime versus the other biologic choices.”

• Asking about patient outcomes. Given Adam’s experience with the Ross Procedure, Dr. Roselli asked for Adam’s input. “Thanks for flipping the script on me,” said Adam. “If I’m in a meeting with a cardiac surgeon about the Ross, I might ask a question like, ‘What are your outcomes with the patients you’ve treated?’ Dr. Roselli responded, “Absolutely important. During meetings and when I’m speaking to surgeons, there is a slide I use all the time about how the patient is at the core of the decision-making process, but the things we take into account are the disease-specific factors. What are the issues with the valve? Is it regurgitant, bicuspid, etc? What does the aorta look like? Other important health considerations about that patient to ask: Do they have other illnesses? What does their lifelong prognosis look like? Then we have to take into account the surgeon and the center’s experience. What is their experience with providing these various options? I’ll often tell a patient that all the options are on the table, but only because we have great experience and know we can deliver the Ross option really well. Some surgeons may not be comfortable with the Ross, so it may not even be an option. Not because it’s not an option for that patient, it’s just not an option for that patient with that surgical team.”

• Questions about complications. Adam said, “If you’re looking for that center with a specialized ability to do the Ross, I might be concerned with complications. What is your history with complications for the Ross, and how do you manage them? Is that also something that plays around in your algorithm?” Dr. Roselli said, “Yes, 100 percent, and if you know your surgical team isn’t comfortable answering those questions about how many they do and their expected outcomes, at least a ballpark figure, then you might want to ask them if there is someone else you should be talking to.”

Thanks Dr. Roselli and the Cleveland Clinic!

On behalf of all the patients in our community, thank you, Dr. Eric Roselli, for everything you and your team are doing at the Cleveland Clinic in Cleveland, Ohio!

Related Links:

• Cardiac Innovation: The Reverse Ross Procedure with Dr. Eric Roselli
• Explore the Ross Procedure Patient Education Center

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Roselli below.