Apicoaortic conduit for left ventricular outflow tract obstruction: Revisited

Background. We have used a variety of techniques to correct left ventricula r outflow tract obstructions, including, in the past, placement of an apico aortic valved conduit to bypass the outflow tract. Because the operation wa s technically difficult, it had fallen into disuse. Recently, we used a sim plified transthoracic approach to implant apicoaortic conduits in 7 patient s with complex lesions of the left ventricular outflow tract. Methods. The thoracic cavity was entered through the fifth intercostal spac e in all 7 patients. The distal end of the valve-containing conduit was att ached to the aorta with continuous 3-0 or 4-0 polypropylene sutures after i ncising the pleura over the distal descending aorta. The pericardium was op ened to expose the left ventricular apex, which was cored so that the proxi mal end of the conduit could be inserted into the left ventricular cavity. Results. Five of the patients recovered completely. The 2 patients who died had severe heart disease and multiple comorbidities. Conclusions. The transthoracic approach gives direct access to the descendi ng aorta and avoids a redo sternotomy. The technique, which is simple to pe rform, does not compromise major coronary arteries, the conduction system, or other valves; and may be useful in patients who are not good candidates for other, more conventional procedures. (C) 2000 by The Society of Thoraci c Surgeons.