Division of Cardiac Surgery Hosts Successful Advanced Ross Procedure Course

The Division of Cardiac Surgery in partnership with LifeNet Health and the Western Thoracic Surgical Association hosted ten cardiothoracic surgeons to take part in a hands-on course on the Ross procedure, a complex double-valve operation with potential survival benefits. During the Ross procedure, a patient’s pulmonary valve is taken out and used to replace a diseased aortic valve. While the Ross procedure is a technically challenging operation, several studies have demonstrated a survival benefit compared to traditional mechanical aortic valve replacement surgeries. Despite its potential advantages, Ross procedures account for less than 0.1% of all valve procedures in the United States according to the National Institutes of Health.

An “incredible opportunity”

The surgeons in attendance had the remarkable opportunity to learn from two experts in the Ross procedure, Distinguished Professor Vaughn A. Starnes, MD, Chairman of the Department of Surgery, and Professor Craig J. Baker, MD, Chief of the Division of Cardiac Surgery and President of the Western Thoracic Surgical Association. After didactic lectures on Thursday, March 6, the visiting surgeons had the chance to watch a Friday morning livestream of Dr. Starnes performing a Ross procedure as Dr. Baker provided commentary. In the afternoon, the surgeons came to the USC Surgical Skills Simulation and Education Center to practice the technique on human hearts and valves as Drs. Baker and Starnes offered technical advice. A couple of Keck School medical students were lucky enough to attend as observers as well.

“This is an incredible opportunity,” said medical student Michael Reckers, who hopes to become a cardiothoracic surgeon. “It’s like a dream!”

A complex procedure for a simplified life

The Ross procedure is generally performed on younger patients with aortic stenosis or inefficiency, usually between 20 and 50 years old. Most aortic valve patients receive either a bovine or porcine tissue valve or a mechanical valve, which requires lifelong anticoagulation. The theory behind the Ross procedure is that an active patient may benefit from having an autograft—a transplant of their own tissue—in the aortic valve position. During the procedure, the patient’s own pulmonary valve is used as a replacement for the aortic valve, and then an allograft is used for the pulmonary valve.

“This is a complex procedure that is not typically learned during standard cardiothoracic surgery training.” noted Dr. Baker.

The advantages, however, can be huge. Adam Pick, the owner of heartvalvesurgery.com, attended the event and collected video footage for further education. He had his own Ross procedure performed by Dr. Starnes 20 years ago. “I’m not on blood thinners,” he said. “I can lead a normal, active life. I go scuba diving! This is a life-changing procedure.”

John Vossler, MD, a pediatric surgeon, pointed out another advantage to the Ross procedure for pediatric patients. “The aortic autograft can grow along with the child. They’ll need to have the pulmonary allograft replaced in 10-15 years, but their aortic valve will be fine.” Vossler also said that recent studies indicate that the Ross procedure is the only aortic procedure that returns adult patients to a normal life expectancy. “Some procedures give you a few years. The Ross procedure gives you your life back.”

The enthusiasm for the potential of the Ross procedure showed as Drs. Starnes and Baker moved from station to station. Veteran surgeons focused intensely on their practice and eagerly took in the advice that Drs. Baker and Starnes had to offer.

The gift of education as a gift of life

Payal Sohoni of LifeNet Health, which provided the hearts and valves, emphasized that the opportunity to work with donated human hearts is invaluable. LifeNet Health’s dedication to honoring donors and advancing education ensures that surgeons leave with the skills to change lives. “These families have approved this use of their loved ones’ hearts for education because they know how much good it will do,” she explained. “Each of these surgeons will perform hundreds of Ross procedures during their careers.” The surgeons at the event took the generosity of these gifts seriously. At the end of the training, each surgeon left a personal note for the families of the donors to show their gratitude.