Demystifying Autograft Assessment and Implantation During the Ross Procedure

The Ross procedure has re-emerged as an important surgical option for aortic valve replacement in carefully selected patients, supported by long-term data demonstrating excellent hemodynamics, durability, and safety. Notably, it remains the only operation capable of restoring normal life expectancy in select patients requiring aortic valve replacement. Despite these advantages, the procedure is performed by few surgeons worldwide and is often undertaken at low volumes with consequent unacceptable risk. The principal barrier to wider adoption is the complexity of the operation, with autograft implantation representing its most nuanced and technically demanding component. This article aims to demystify this critical aspect of the Ross procedure by presenting a simplified and systematic approach to autograft assessment and implantation, with the goal of enhancing reproducibility, safety, teachability, and utilization.