Long-term results of Konno procedure for complex left ventricular outflow tract obstruction
Takahiko Sakamoto1, Goki Matsumura, Yoshimichi Kosaka
1Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan. takasakamoto@yahoo.co.jp <takasakamoto@yahoo.co.jp>
Insights
The Konno procedure demonstrates effective long-term outcomes for complex left ventricular outflow tract obstruction, preserving cardiac function. Careful monitoring is essential due to potential complications like anticoagulation issues and endocarditis.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Cardiac Valve Repair and Replacement
Background:
- The Konno procedure is a surgical technique for complex left ventricular outflow tract obstruction.
- Evaluating long-term outcomes is crucial for assessing the procedure's efficacy and safety.
Purpose of the Study:
- To assess the long-term clinical outcomes and survival rates following the Konno procedure.
- To identify complications and reintervention rates associated with the Konno procedure.
Main Methods:
- Retrospective review of clinical records for 63 patients who underwent the Konno procedure between 1984 and 2007.
- Kaplan-Meier survival analysis and assessment of complication rates.
- Echocardiographic evaluation of cardiac function post-procedure.
Main Results:
- Survival rates were 91.9% at 10 years and 87.7% at 15 years, including hospital and late mortality.
- Significant complications occurred in 16 patients, with reoperations required in 9 patients.
- Event-free rates were 75.2% at 10 years and 67.2% at 15 years; echocardiography showed good long-term cardiac function.
Conclusions:
- The Konno procedure is effective and safe for treating complex left ventricular outflow tract obstruction.
- The procedure aids in preserving ventricular function.
- Ongoing vigilance for anticoagulation-related complications and infectious endocarditis is necessary.
Objective:
The current study aims to evaluate the long-term outcomes of the Konno procedure.
Methods:
The clinical records of 63 patients who had undergone the Konno procedure between February 1984 and March 2007 were reviewed. During this period, the Ross procedure was introduced in 1996. Of the 63 patients, 38 were male and 25, female. Their ages at the time of operation ranged from 1 year 9 months to 37 years, and their body weights ranged from 8.1 to 63 kg. Valves larger than 23 mm were used in 57 patients.
Results:
There was one hospital death (myocardial infarction) and six late deaths (sudden death, 2; congestive heart failure, 2; infectious endocarditis, 1; traffic accident, 1). The Kaplan-Meier survival rates including hospital mortality and late mortality were 91.9% at 10 years and 87.7% at 15 years. There were 20 significant complications in 16 patients: thromboembolism was noted in 1 patient; reoperations (Konno procedure (aortic valve replacement), 5 (thrombosed valve, 3; pannus formation, 1; IE, 1); mitral valve replacement, 3; coronary artery bypass grafting, 2; grafting of the descending aorta, 1), balloon dilatation for recoarctation, and 7 catheter interventions were required in 9, 1, and 5 patients, respectively. The event-free rates including all events were 75.2% at 10 years and 67.2% at 15 years. In the long-term period, the results of echocardiography revealed good cardiac function.
Conclusions:
The Konno procedure is effective and safe for the treatment of complex left ventricular outflow tract obstruction and for the preservation of ventricular function. Since some issues concerning anticoagulation-related complications and infectious endocarditis remain, careful observation is mandatory.
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