Building a Ross Procedure Program, Keys to Success
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0072
Submission Type:
Abstract Submission
Authors:
Mohammad El Diasty (1), Travis Wilder (1), Yasir Abu-Omar (1), Rakesh Arora (1), Cristian Baeza (1), Kelsey Gray (1), Igo Ribeiro (1), Pablo Ruda Vega (1), Gregory Rushing (1), Marc Pelletier (1), Joseph Sabik (1), Yakov Elgudin (1)
Institutions:
(1) University Hospitals Cleveland Medical Center, Cleveland, OH
Submitting Author:
Mohammad El Diasty
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Co-Author(s):
Travis Wilder
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
*Yasir Abu-Omar
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
*Rakesh Arora
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Cristian Baeza
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Kelsey Gray
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Igo Ribeiro
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Pablo Ruda Vega
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Gregory Rushing
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
*Marc Pelletier
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
*Joseph Sabik
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Yakov Elgudin
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Presenting Author:
Mohammad El Diasty
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Abstract:
Objectives
This abstract provides a roadmap for launching a successful Ross procedure surgical program with focus on the logistics of team building and streamlining patient management to mitigate the impact of a steep learning curve on surgical outcomes.
Methods
This is a narrative description of a division's experience with the initiation of a surgical program dedicated to performing Ross procedure. We describe the process and provide tips that we believe have contributed to the success of the program.
Results
Surgical Training: The program was initiated by two experienced surgeons with experience in aortic root surgery and with defined goals for a successful program. A list of potential patients was developed. The surgeons attended a formal training course at a center of excellence in Ross procedures. This course was comprised of dedicated lectures, wet lab sessions, and live surgery observation. Surgeons participated in other wet labs, including one on the morning before performing their first case, aided by a proctoring surgeon with Ross procedure expertise. Two attending surgeons worked together in all cases and three other surgeons were added as the program grew to form a core group.
Patient Selection: A patient selection pathway with specific eligibility criteria was established and distributed among all cardiac surgeons and referring cardiologists to ensure the capture of potential Ross procedure candidates.
Standardized Procedure: Efforts were made to standardize all aspects of the surgery. On the day of surgery, team members (including surgeons, anaesthesiologists, scrub nurses, and perfusionist) participated in a comprehensive team huddle to discuss the technical details of the planned procedure and any potential variations.
Postoperative Care: An internal standardized order set was used to ensure that all members of the intensive care team managed these patients in a cohesive manner. This included specific instructions on fluid management, inotropic/vasopressor support, and target blood pressure in the immediate postoperative period.
Follow-up: All Ross patients are captured in an institutional database, including clinical and radiological parameters for all patients. A dedicated nurse practitioner was designated to provide regular contact with patients after discharge to ensure full adherence to strict blood pressure targets for the first 6 months after surgery.
Monitoring Outcomes: A standardized quality process was utilized to continually review surgical outcomes and detailed multidisciplinary team discussions were held to review any serious complications.
Program growth timeline: The program was launched in July 2022. During the planning phase (0-2 months), surgeons attended preparatory courses and wet labs. The following phase lasted for the next 6-8 months, during which, surgeons performed their first cases where they double scrubbed with each other for support and to gain more exposure to the procedure. After that, three more experience surgeons from the team started performing the procedure under the proctorship of the two lead surgeons. The detailed program structure is presented in Figure 1.
Conclusions
Building a successful program for Ross procedure requires meticulous planning, team building, and a standardized perioperative care pathway. These factors contribute to the program development and the achievement of excellent surgical results.
This abstract provides a roadmap for launching a successful Ross procedure surgical program with focus on the logistics of team building and streamlining patient management to mitigate the impact of a steep learning curve on surgical outcomes.
Methods
This is a narrative description of a division's experience with the initiation of a surgical program dedicated to performing Ross procedure. We describe the process and provide tips that we believe have contributed to the success of the program.
Results
Surgical Training: The program was initiated by two experienced surgeons with experience in aortic root surgery and with defined goals for a successful program. A list of potential patients was developed. The surgeons attended a formal training course at a center of excellence in Ross procedures. This course was comprised of dedicated lectures, wet lab sessions, and live surgery observation. Surgeons participated in other wet labs, including one on the morning before performing their first case, aided by a proctoring surgeon with Ross procedure expertise. Two attending surgeons worked together in all cases and three other surgeons were added as the program grew to form a core group.
Patient Selection: A patient selection pathway with specific eligibility criteria was established and distributed among all cardiac surgeons and referring cardiologists to ensure the capture of potential Ross procedure candidates.
Standardized Procedure: Efforts were made to standardize all aspects of the surgery. On the day of surgery, team members (including surgeons, anaesthesiologists, scrub nurses, and perfusionist) participated in a comprehensive team huddle to discuss the technical details of the planned procedure and any potential variations.
Postoperative Care: An internal standardized order set was used to ensure that all members of the intensive care team managed these patients in a cohesive manner. This included specific instructions on fluid management, inotropic/vasopressor support, and target blood pressure in the immediate postoperative period.
Follow-up: All Ross patients are captured in an institutional database, including clinical and radiological parameters for all patients. A dedicated nurse practitioner was designated to provide regular contact with patients after discharge to ensure full adherence to strict blood pressure targets for the first 6 months after surgery.
Monitoring Outcomes: A standardized quality process was utilized to continually review surgical outcomes and detailed multidisciplinary team discussions were held to review any serious complications.
Program growth timeline: The program was launched in July 2022. During the planning phase (0-2 months), surgeons attended preparatory courses and wet labs. The following phase lasted for the next 6-8 months, during which, surgeons performed their first cases where they double scrubbed with each other for support and to gain more exposure to the procedure. After that, three more experience surgeons from the team started performing the procedure under the proctorship of the two lead surgeons. The detailed program structure is presented in Figure 1.
Conclusions
Building a successful program for Ross procedure requires meticulous planning, team building, and a standardized perioperative care pathway. These factors contribute to the program development and the achievement of excellent surgical results.
Aortic Symposium:
Aortic Root
Image or Table
