Table 2 Characterization of the Ross procedure using an implementation lens

Intervention characteristics

• Complex procedure

• Required adaptation of surgical techniques for optimization

• Influence of center volume on outcomes

Inner and outer setting

• Complications and poor outcomes imbued social and cultural concerns on safety/efficacy leading to abandonment and disillusionment

Individuals involved

• Organizational uncertainty

• Influence on provider perceptions

• Further confusion over procedural efficacy

Implementation process

• Slow incorporation into guideline