Global Perspectives on the Ross Procedure: A Comprehensive International Survey

Objectives Recent data demonstrating superior outcomes and enhanced life expectancy with the Ross procedure (RP) have sparked renewed interest and increased utilization. However, the RP remains technically challenging compared to conventional aortic valve replacement (AVR), necessitating specialized expertise and careful patient selection. This study provides global insights into current RP practices to establish best practices and inform new or evolving programs. Methods A web-based survey (> 60 questions) was distributed globally to cardiac surgeons known to perform the RP from May 1 to June 30, 2023. The survey queried surgeon experience, RP volumes, patient selection criteria, preoperative imaging, intraoperative techniques, and postoperative care practices. Responses were analyzed to identify global trends and optimal approaches for RP management. Results Of the 167 respondents, 123 (74%) performed the RP, with 75% performing 5 to 30 procedures annually. Approximately half involved a second attending surgeon. Most treated younger patients and preferred homografts for right ventricular outflow tract reconstruction. Variations existed in the ventriculoaortic and sinotubular junction support (30% vs 45% always support). Most surgeons (89%) enforce strict blood pressure control postoperatively, with 65% prescribing beta-blockers. About 54% use postoperative inflammatory prophylaxis, and 90% obtain imaging prior to discharge, with 78% performing annual echocardiograms. Conclusions This international survey highlights wide variability in RP practices, underscoring the need for standardized training and procedural protocols. These insights may guide new or evolving RP programs, improve access, and ensure durable outcomes by aligning global practices with contemporary evidence.