Where do you go for heart surgery that almost no one in the US can perform? The answer—as it is so often—is Temple Health. In this case, it’s the Ross procedure, which is used to treat aortic valve disease: a condition caused by a damaged aortic valve in the heart. Often the result of a birth defect, aortic valve disease can cause everything from shortness of breath to, in the long term, a serious cardiac event like stroke or heart attack.
“The Ross procedure is the only option for treating aortic valve disease that gives patients a similar chance of survival as the general population,” says Yoshiya Toyoda, MD, PhD, Chief of Cardiovascular Surgery at Temple University Hospital. Dr. Toyoda is one of the few surgeons in the nation who performs the highly complex procedure and has introduced several innovations to make it even more safe and effective.
The Ross procedure is now the preferred option for many aortic valve disease patients, as it allows patients to live their lives with minimal restrictions and means they won’t have to undergo another surgery for up to 20 years. “For the young, active patient, this is the best procedure,” Dr. Toyoda explains.
Fewer Complications, Improved Outcomes
Developed in 1960s by British surgeon Donald Ross, the complexity of what became known as the Ross procedure made it controversial in its day, to the point that it was almost abandoned. However, improved surgical techniques led to adjustments to the procedure and its resurgence at highly-specialized medical centers like Temple Health—and its success when performed by surgeons with the requisite skill and experience, like Dr. Toyoda.
What makes the Ross procedure so revolutionary? It allows patients to avoid many of the complications caused by more common aortic valve disease treatment options. If a patient were to have a mechanical valve or a valve created from cow or pig tissue implanted, for example, the procedure would have to be redone every several years, and the patient would have to take anticoagulation medication for the rest of their life.
“This medication can result in serious bleeding complications over time,” Dr. Toyoda explains. But with the Ross procedure, patients don’t have to worry about that, thanks to a technique called the “autograft.” That’s when the pulmonary valve is taken from the patient’s heart and used to replace the damaged aortic valve. A donor human pulmonary valve then replaces the pulmonary valve that’s been removed. The autograft works well because the pulmonary valve is taken from the patient’s own body, which means it is live tissue, it is physiological, it lasts longer, and there’s no need for medication.
Physically active patients don’t have to change their lifestyle, either: because the pulmonary valve can expand and contract more naturally than an artificial valve, patients’ cardiac activity isn’t impaired. This also makes the Ross procedure ideal for pregnant patients, as the valve can handle the increased cardiovascular strain during pregnancy. Younger patients are also excellent candidates for the procedure, as the valve can grow alongside the rest of the body.
It Takes Temple (and Toyoda)
Because it means replacing two different valves, the Ross procedure is exceptionally complex—which is why only a few of the nation’s leading cardiac surgeons can execute it successfully. And even among this elite group, Dr. Toyoda stands out: because the heart’s recovery depends on minimizing the time it takes for the valves to be replaced (known as “cross-clamp time”), surgeons who have mastered performing both types of valve procedures as quickly as possible have the best outcomes.
“The shorter the cross-clamp time, the better,” Dr. Toyoda explains. “My cross-clamp times are generally shorter than the times reported by other centers performing the procedure around the world.” That means faster, more complete recoveries—and healthier patients.
Dr. Toyoda has also pioneered new innovations that make the Ross procedure safer and more effective. Those include harvesting the autograft prior to clamping the aorta, which has increased the procedure’s efficacy and viability, making it an option for many more physicians and patients. His research has also shown that the Ross procedure decreases the risk of reinfection when compared to the use of a prosthetic valve.
Working Towards Perfection
While the Ross procedure is still only available at select institutions, Dr. Toyoda is committed to making it accessible nationwide. “Fortunately, there are more training courses and conferences now to educate interested surgeons,” says Dr. Toyoda, who leads many of these seminars on the technique. The American Heart Association now recommends it as a solution for aortic valve disease, and he hopes they might broaden this recommendation as more research is published.
In the meantime, Dr. Toyoda is working hard to refine the technique even further. “I look for an opportunity to improve every time I do the procedure,” he says.