Konno-aortoventriculoplasty with mechanical prosthesis in dealing with small aortic root: a good surgical option

OBJECTIVE: This study was undertaken to evaluate the effectiveness and the results with the Konno-aortoventriculoplasty. METHODS: Over a 10-year period, 21 Konno-aortoventriculoplasties were performed in 20 patients utilizing mechanical cardiac valvular prostheses, in 14 male and 6 female patients for complex left ventricular outflow tract stenosis. The mean age was 9.2 years (range 1.7-25.7 years). The pre-enlargement mean aortic annular size was 11.5 mm (6-16 mm). The mean size of the prostheses implanted was 20.4 mm (19-23 mm). In a typical case, the aortic annulus was enlarged to twice its original size. RESULTS: The only operative death was in a 8 kg, 20-month old child with previous commissurotomy, due to intractable bleeding and low output state. The mean hospital stay was 9.4 days (1-15 days), and the mean ICU stay was 3.3 days (1-7 days). The only late death was in a patient who went on to have cardiac transplantation for progressive left ventricular dysfunction. The 10-year acturial survival was 90 ± 7%, and the reoperation free survival was 89 ± 7%. All of the 18 surviving patients are asymptomatic at the time of last clinic visit (mean follow-up of 61.1 ± 31.7 months, range 0-139 months). All patients had resolutions of their left ventricular hypertrophy with insignificant gradient across the repair by echocardiography. CONCLUSIONS: Konno-aortoventriculoplasty is extremely effective in the treatment of small aortic annuli and complex left ventricular outflow tract obstruction. In the present era of increasing popularity of autograft and homograft operations, the Konno procedure should remain in the technical armamentarium of the cardiac surgeon.