The Ross Procedure: Modern Techniques, Durability, & Lifetime Valve Management with Dr. Malaisrie and Dr. Pop

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 centersTechniques 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 remodelingDurability data: 85–90% freedom from reintervention at 10 yearsManaging failures: surgical re-repair, TAVR options, and future dedicated devicesPatient selection: under 50, women, and those with small aortic rootsThe role of root enlargement and replacement in lifetime managementMinimally invasive approaches: mini-thoracotomy vs sternotomyTAVR-first vs surgery-first strategies in younger patientsWhy the valve clinic model and shared decision-making matter in 2025This 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#RossProcedure #AorticValve #CardiacSurgery #ValveSurgery #StructuralHeart #TAVR #LifetimeManagement #ValveClinic #InterventionalCardiology #MurmurMD