AORTOVENTRICULOPLASTY WITH THE PULMONARY AUTOGRAFT - THE ROSS-KONNO PROCEDURE

Background: For patients with complex left ventricular outflow tract o bstruction, including hypoplastic aortic anulus with or without severe diffuse subaortic stenosis, various aortoventriculoplasty procedures (e.g., Konno procedure and its modifications; extended aortic allogaft root replacement) are important management options, In younger patien ts, however, reoperation for valve replacement is inevitably required, and anticoagulation issues pose additional problems, The pulmonary au tograft provides a promising option for aortic valve replacement as pa rt of the aortoventriculoplasty procedure in children, Long-term follo w up shows that the pulmonary autograft functions well as the systemic arterial (neoaortic) valve and that valve growth occurs, Methods: Bet ween July 1993 and May 1995, 11 patients 4 days to 17 years old (media n 12 months) underwent aortoventriculoplasty with pulmonary autograft (Ross-Konno procedure), The diagnoses were aortic stenosis with or wit hout subaortic stenosis (n = 8), Shone complex (n = 2), and interrupte d aortic arch with subaortic stenosis (n = 1). On average, 1.9 previou s interventions had been performed per patient, including a previous K onno procedure in one patient, The aortic root was replaced with a pul monary autograft valve, The left ventricular outflow tract was enlarge d with a Dacron polyester fabric patch in two patients, with an allogr aft aortic patch in two patients and a right ventricular infundibular free wall muscular extension harvested in continuity with the autograf t in seven patients, Results: Intraoperative transesophageal echocardi ographic assessment revealed mild aortic insufficiency in one patient, One patient had a residual left ventricular outflow tract gradient of 15 mm Hg, Significant complications were cardiac tamponade from bleed ing (n = 1) and complete heart block necessitating a permanent pacemak er (n = 1). Follow-up ranged from 2 weeks to 16 months. To date, there have been no late deaths or reoperations. Follow-up echocardiography revealed mild autograft insufficiency in one patient and a 16 mm Hg re sidual left ventricular outflow tract gradient in one patient, Conclus ions: Initial experience suggests that aortoventriculoplasty with the pulmonary autograft is an excellent alternative for young patients wit h complex left ventricular outflow tract obstruction, Because the pulm onary autograft has been shown to grow after implantation, reoperation on the left ventricular outflow tract is likely to be avoided.