The Konno aortoventriculoplasty for repeat aortic valve replacement

Objective: To evaluate the outcome of aortic root augmentation by the Konno -aortoventriculoplasty technique as part of reoperative aortic valve replac ement. Methods: Since 1983, 15 patients, 12 males and three females, had re peat aortic valve replacement (AVR) with concomitant Konno aortoventriculop lasty. Age ranged from 1.2 to 18 years (mean 12.5 years). The underlying an atomic diagnoses were valve and subvalvar aortic stenosis in 11, truncal va lve insufficiency in one, endocarditis in one, Shone's complex in one and s evere aortic insufficiency associated with a ventricular septal defect in o ne patient. All patients had had previous AVR. The causes for reoperation w ere prosthetic valve stenosis due to growth in ten and paravalvular leak in one, homograft failure in two, xenograft failure in one, and left ventricu lar outflow tract obstruction (LVOTO) after mitral valve replacement in one patient. The mean size of explanted prostheses was 19.2 min (13-23 mm) whi le the mean size of the implanted prostheses was 24.3 mm (19-27 mm) (P < 0. 01). Previous aortic root enlargement had been performed in 11 patients in conjunction with AVR. The Manougian technique was used previously in two, K onno aortoventriculoplasty in eight, and both techniques in one patient, Th e newly implanted aortic valves were a homograft in one patient and mechani cal prostheses in 14 patients. Results: There was one operative death (1 of 15 or 6.6%) in a 17.5 year old patient with previous AVR and posterior roo t enlargement, due to low cardiac output state. Follow-up ranged from 6 mon ths to 17 years (mean 7.2 years). The only late death occurred in an 11.6-y ear-old patient due to prosthetic valve endocarditis. Two patients had comp lete heart block and had permanent pacemaker insertion (2 of 15 or 13.3%). One patient had pulmonary valve replacement because of combined stenosis an d insufficiency 5 years after operation. All 13-surviving patients are asym ptomatic at latest follow up. Conclusion: Konno aortoventriculoplasty with repeat AVR may be safely performed. Excellent results may be achieved despi te previous aortic root enlargement. It is a good surgical option For compl ex LVOTO and may even reduce reoperation in children by allowing placement of a larger prosthesis. (C) 2001 Elsevier Science B.V. All rights reserved.