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Long-term results of Konno procedure for complex left ventricular outflow tract obstruction

Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan

Received 22 September 2007; received in revised form 22 March 2008; accepted 31 March 2008.

^_* Corresponding author. Present address: Nagano Children's Hospital, Japan. Tel.: +81 3 3353 8111; fax: +81 3 3356 0441. (Email: takasakamoto{at}yahoo.co.jp).

Objective: The current study aims to evaluate the long-term outcomes of the Konno procedure. Methods: The clinical records of 63 patients who had undergone the Konno procedure between February 1984 and March 2007 were reviewed. During this period, the Ross procedure was introduced in 1996. Of the 63 patients, 38 were male and 25, female. Their ages at the time of operation ranged from 1 year 9 months to 37 years, and their body weights ranged from 8.1 to 63 kg. Valves larger than 23 mm were used in 57 patients. Results: There was one hospital death (myocardial infarction) and six late deaths (sudden death, 2; congestive heart failure, 2; infectious endocarditis, 1; traffic accident, 1). The Kaplan–Meier survival rates including hospital mortality and late mortality were 91.9% at 10 years and 87.7% at 15 years. There were 20 significant complications in 16 patients: thromboembolism was noted in 1 patient; reoperations (Konno procedure (aortic valve replacement), 5 (thrombosed valve, 3; pannus formation, 1; IE, 1); mitral valve replacement, 3; coronary artery bypass grafting, 2; grafting of the descending aorta, 1), balloon dilatation for recoarctation, and 7 catheter interventions were required in 9, 1, and 5 patients, respectively. The event-free rates including all events were 75.2% at 10 years and 67.2% at 15 years. In the long-term period, the results of echocardiography revealed good cardiac function. Conclusions: The Konno procedure is effective and safe for the treatment of complex left ventricular outflow tract obstruction and for the preservation of ventricular function. Since some issues concerning anticoagulation-related complications and infectious endocarditis remain, careful observation is mandatory.

Key Words: Konno procedure • Ross procedure • Long-term outcomes