Long-term results of apico-aortic valved conduit - for severe idiopathic hypertrophic subaortic stenosis

We report our long-term results of apico-aortic conduit implantation in pat ients with isolated idiopathic hypertrophic subaortic stenosis. Between Dec ember 1977 and July 1983, apico-aortic prosthetic-valved conduits were impl anted in 4 such patients (age range, 24-65 years) who had severe left ventr icular hypertrophy and small left ventricular chambers. In this procedure, the distal end of the conduit was anastomosed to the ascending aorta in 3 p atients and to the upper abdominal aorta in 1. Postoperative echocardiograp hy showed relief of the left ventricle-aortic gradient and enlargement of t he left ventricular chamber in all cases. One patient died of perioperative wound infection. One patient died of unnatural causes 13 years after the i nitial operation; in his case, the conduit was known to be occluded. Two pa tients are alive 15 and 19 years, respectively, after the initial operation . Three instances of conduit obstruction due to bioprosthetic calcification w ere observed. Despite the high incidence of reoperation due to conduit valv e failure, apico-aortic conduit implantation has produced good hemodynamic outcome and has improved the quality of life in patients who have idiopathi c hypertrophic subaortic stenosis and anatomic features unsuitable for Morr ow's operation. Improvements in bioprostheses and in apical implantation te chniques may allow a revival of apico-aortic conduit implantation in select ed patients with idiopathic hypertrophic subaortic stenosis.