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Late Outcomes of Konno-Rastan and Modified Konno for Left Ventricular Outflow Tract Obstruction

Elaine M Griffeth1, Joseph A Dearani1, Kenneth R Hassler1

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.

The Annals of Thoracic Surgery
|July 21, 2023
PubMed

Insights

Long-term follow-up of Konno-Rastan and modified Konno procedures reveals recurrent left ventricular outflow tract (LVOT) obstruction over time. Despite preserved heart function, late survival remains poor in young patients after these complex surgeries.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Early outcomes of Konno-Rastan and modified Konno procedures are established.
  • Long-term clinical and echocardiographic outcomes of these complex left ventricular outflow tract (LVOT) obstruction surgeries remain largely undetermined.

Purpose of the Study:

  • To examine the long-term clinical and echocardiographic outcomes of patients who underwent Konno-Rastan and modified Konno procedures.
  • To identify risk factors associated with mortality in this patient population.

Main Methods:

  • Retrospective review of 92 patients undergoing Konno-Rastan or modified Konno for complex LVOT obstruction (1980-2021).
  • Exclusion of the Ross-Konno procedure due to limited ventriculotomy.
  • Analysis of clinical data, echocardiographic parameters, reoperation rates, and overall survival.

Main Results:

  • Median follow-up was 12 years. Aortic valve/LVOT mean gradient increased from 13 mm Hg at 1 year to 25 mm Hg at 10 years.
  • Freedom from reoperation at 10 years was 58.4% for Konno-Rastan and 41.7% for modified Konno.
  • Overall survival at 15 years was 65.5%. Risk factors for mortality included older age, NYHA class III/IV, longer cardiopulmonary bypass time, and multilevel LVOT obstruction.

Conclusions:

  • Recurrent LVOT obstruction occurs over time following Konno-Rastan and modified Konno procedures.
  • Despite preserved left ventricular systolic function, late overall survival is poor in this young patient population.
  • These findings highlight the need for long-term monitoring and potential reinterventions.
Abstract

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