How I Teach It: The Ross Procedure Using Explanted Hearts During Orthotopic Heart Transplantation

The Ross Procedure (RP) is a technically complex opera-tion for aortic valve replacement (AVR) in selected pa-tients. We describe a novel approach to simulating this operation using explanted native hearts during heart transplantation. Consent was obtained. The aortic root is dissected away from the pulmonary artery (PA). The pulmonary autograft is harvested and then transferred into the aortic position, and coronary buttons are reimplanted. The explanted heart is submitted for pathologic analysis. Six explanted hearts have been used for simulation thus far. Participating trainees reported high degrees of satis-faction. This high-fidelity simulation is an effective way to increase trainee exposure to the RP.