Recurrent subaortic membrane removal with homograft explant

This 27-year-old female patient is undergoing a reoperation for a recurrent subaortic membrane causing significant left ventricular outflow obstruction. The re-sternotomy is uneventful and cardiopulmonary bypass is established. The left ventricular outflow tract is accessed through the previously implanted semi-calcified homograft aortic root. The fibrous tissue of the subaortic membrane is resected as a crescent, along with a septal myectomy. The aortic annulus and previous aortic homograft are resected to enlarge the aortic root from 12 mm to 21 mm. The left ventricular outflow tract is then reconstructed with pericardium, and a valved conduit aortic root replacement, size 21 mm Konect prosthesis, is implanted. The pericardium is closed with Gore-Tex membrane, should future surgery be needed. A 21-mm valve was considered adequate, given her height of 157 cm and low body surface area of 1.45 m2. This patient was not an appropriate candidate for a Ross-Konno procedure or a mechanical valve due to extremely challenging social circumstances, medical noncompliance and housing insecurity.