Once considered niche, the Ross procedure is making a strong comeback. With improved techniques and long-term outcomes, it’s becoming a first-line option for younger patients with aortic valve disease.

In this episode, Dr. Chris Malaisrie (Northwestern Memorial, Chicago) joins Dr. Andrei Pop to discuss:

• Why the Ross procedure is resurging in high-volume centers

• Techniques to stabilize the autograft and prevent dilation (deep LVOT implant, Dacron grafts, wrapping with native root)

• Post-op strategies including strict blood pressure control for favorable remodeling

• Durability data: 85–90% freedom from reintervention at 10 years

• Managing failures: surgical re-repair, TAVR options, and future dedicated devices

• Patient selection: under 50, women, and those with small aortic roots

• The role of root enlargement and replacement in lifetime management

• Minimally invasive approaches: mini-thoracotomy vs sternotomy

• TAVR-first vs surgery-first strategies in younger patients

• Why the valve clinic model and shared decision-making matter in 2025

This is a must-watch for surgeons, interventional cardiologists, and valve clinic teams navigating lifetime aortic valve management.

Chapters:

00:00 – Intro & guest background

01:00 – Why the Ross procedure is resurging

02:15 – Stabilizing the autograft: surgical techniques

04:00 – Blood pressure control & early remodeling

05:20 – Jacketed Ross and long-term durability

06:30 – Failure rates and freedom from reintervention

07:15 – Options for failing autografts & future TAVR devices

10:30 – Homografts vs autografts: differences in calcification

12:00 – Ross volumes, outcomes, and national trends

13:30 – Patient selection: under 50, women, and small roots

14:15 – Root enlargement and replacement strategies

20:00 – CT planning and AI modeling for AVR

21:15 – Minimally invasive AVR: mini-thoracotomy vs sternotomy

22:15 – TAVR first vs Ross first in younger patients

23:30 – Challenges with TAVR explant vs SAVR explant

26:00 – Techniques for safe TAVR explant

27:00 – TAV-in-TAV as a lifetime strategy

28:30 – Coronary protection & unicorn procedure

31:30 – Valve clinics & shared decision-making

33:15 – The debate over single-operator TAVR

35:00 – Closing thoughts & takeaways

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