The Ross Procedure offers a life-saving, durable, and innovative heart valve solution, yet remains significantly underutilized in India despite its proven success globally.
1. Superior Outcomes for Younger Patients:
Haemodynamic Advantage: The Ross Procedure utilizes the patient’s own pulmonary valve to replace the diseased aortic valve. This “autograft” behaves much like a native valve, offering excellent blood flow (hemodynamics) that closely mimics a healthy heart. This is particularly crucial for young, active individuals as it allows them to participate in strenuous activities without the limitations often associated with artificial valves.
Growth Potential: For children and adolescents with aortic valve disease, the autograft can grow with their body, potentially avoiding multiple re-operations needed with fixed-size prosthetic valves.
Avoidance of Anticoagulation: Unlike mechanical heart valves, the Ross Procedure typically doesn’t require lifelong blood-thinning medication (anticoagulants). This significantly reduces the risk of bleeding complications and allows for a more unrestricted lifestyle.
Improved Long-Term Survival: Studies have shown that in younger adults, the Ross Procedure is associated with long-term survival rates comparable to the general population, and in some cases, better than with mechanical or bioprosthetic valves.
2. Addressing India’s Demographics and Disease Profile:
Young Population: India has a large young population, a significant portion of whom may be affected by congenital heart conditions like bicuspid aortic valves, often requiring aortic valve replacement in their youth or early adulthood. The Ross Procedure offers these individuals a superior long-term solution.
Late Diagnosis: Often, congenital heart defects are diagnosed later in India. The Ross Procedure can still be a viable option for these young adults, offering them a chance at a normal, active life without the burden of lifelong medication.
3. Potential for Reduced Long-Term Costs:
While the initial Ross Procedure is technically complex, avoiding lifelong anticoagulation and potential re-operations associated with prosthetic valves could translate to lower healthcare costs for patients in the long run.
4. Growing Expertise in India:
Institutions like Narayana Health City have demonstrated expertise in performing the Ross Procedure with excellent long-term outcomes, as highlighted by Dr. Varun Shetty’s 20-year follow-up study. This indicates that the technical expertise exists within India to make this procedure more widely available.
5. Patient Preference and Quality of Life:
Many younger patients, when informed about the options, may prefer the Ross Procedure due to the freedom from anticoagulation, better haemodynamics, and the potential for a more active lifestyle.
Why it Remains a “Best-Kept Secret”:
Despite these advantages, the Ross Procedure isn’t widely adopted in India due to:
Technical Complexity: It is a surgically demanding procedure requiring specialized skills and experience. This limits the number of surgeons and centers capable of performing it.
Steep Learning Curve: Cardiac surgeons need significant training and practice to achieve consistent positive outcomes with the Ross Procedure.
Lack of Awareness: Many patients and even some referring physicians may not be fully aware of the benefits and suitability of the Ross Procedure, especially compared to more conventional valve replacements.
Dominance of Traditional AVR: Mechanical and bioprosthetic valve replacements are more established and widely practiced, making them the default choice for many.
Concerns about Autograft Durability: While long-term data is encouraging, some concerns about the long-term durability of the autograft and the need for potential re-interventions persist among some practitioners.