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Long-Term Results of the Konno Procedure for Complex Left Ventricular Outflow Tract Obstruction

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To determine the long-term clinical and echocardiographic outcome after the Konno-Rastan aortoventriculoinfundibuloplasty (Konno procedure) for complex left ventricular outflow tract (LVOT) obstruction.
The records of 53 patients (pt) who underwent the Konno procedure between January 1, 1980 and January 1, 2004 were reviewed. Excluded from analysis were 5 other pt who underwent the Ross-Konno procedure.
The mean age at operation was 19 years (range, 1-65 yr) and there were 27 (51%) males. Prior to the Konno procedure, 66 operations had been performed in 41 (77%) pt to relieve LVOT obstruction. Indications for the Konno procedure were complex subaortic / tunnel stenosis in 22 (41%), multilevel LVOT obstruction in 20 (38%) and aortic valve stenosis / hypoplasia in 11 (21%). A total of 33 (62%) pt had greater than NYHA class I symptoms preoperatively. A mechanical aortic valve was implanted in 40 (75%), a homograft in 10 (19%) and a biological prosthesis in 3 (6%). Mortality at 30 days was 8% (n=4) (95% confidence interval (CI) 2-18%). Nonfatal complications included heart block (7), sepsis (2), bleeding (2), respiratory failure (1) and renal failure (1). Follow-up ranged from 0 to 21 yr (median 5.2 yr). Mortality at 10 yr was 16% (95% CI 4-26%). The only risk factor for overall mortality identified was longer bypass time (HR=2.3/hour, p=0.02). The cumulative probability of aortic valve reoperation was 17% (95 % CI 4-28%) at 5 yr and 40% at 10 yr (95% CI 17-57), occurring in 14 pt at a median of 4.3 yr. Indications for aortic reoperation were valve stenosis in 7, regurgitation in 4 and endocarditis in 3. Causes of other cardiac reoperations were ventricular septal defect in 2 and pulmonary valve regurgitation in 1. A total of 102 follow-up echos were available for review in 46 pt and were divided into categories from the date of operation: <1year, 1-3 yr and 3-5 yr. The average LVOT gradient (mmHg) at 1 yr was 19 (n=9), 13 (n=9) at 1-3 yr and 13 (n=5) at 3-5 yr. Pulmonary regurgitation was detected in 4 pt and was mild in 1, moderate in 2 and severe in 1. At the date of last contact, 43 pt were still alive, and 37 were in NYHA class I or II.
The Konno procedure is durable, allowing both long-term reduction of LVOT obstruction and improvement in functional class. Prosthetic aortic valve and, infrequently, native pulmonary valve complications may necessitate reoperation.
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