The Konno aortoventriculoplasty for repeat aortic valve replacement

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiac Surgery
• Aortic Valve Surgery

Background:

• Reoperative aortic valve replacement (AVR) is complex, especially with prior aortic root enlargement.
• Left ventricular outflow tract obstruction (LVOTO) in children often necessitates complex surgical interventions.
• The Konno-aortoventriculoplasty technique is a method for aortic root augmentation.

Purpose of the Study:

• To evaluate the outcomes of the Konno-aortoventriculoplasty technique in reoperative aortic valve replacement.
• To assess the safety and efficacy of aortic root augmentation in pediatric patients undergoing repeat AVR.
• To determine the impact of this technique on managing complex LVOTO and prosthesis size.

Main Methods:

• A retrospective review of 15 patients (1.2-18 years) who underwent repeat AVR with Konno-aortoventriculoplasty since 1983.
• Patients had various underlying diagnoses including aortic stenosis and insufficiency, with prior AVRs.
• Analysis included pre- and post-operative valve sizes, previous root enlargement procedures, and complications.

Main Results:

• One operative death (6.6%) occurred due to low cardiac output.
• Follow-up (mean 7.2 years) showed one late death from prosthetic valve endocarditis.
• 13.3% of patients required permanent pacemaker insertion for heart block; all surviving patients were asymptomatic.

Conclusions:

• Konno-aortoventriculoplasty is a safe and effective option for reoperative AVR, even with previous aortic root enlargement.
• The technique facilitates the implantation of larger aortic prostheses, potentially reducing reoperation rates in pediatric patients.
• It is a valuable surgical approach for complex LVOTO in children.