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

Rakesh M. Suri, Joseph A. Dearani, Hartzell V Schaff, Gordon K. Danielson, Francisco J. Puga

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: This study was undertaken to determine long-term clinical and echocardiographic outcomes after the Konno procedure. Methods: Fifty-three patients who underwent the Konno procedure between January 1, 1980, and January 1, 2004, were reviewed. Results: Mean age at operation was 19 years (range, 1-65 years). Indications were as follows: complex subaortic or tunnel stenosis in 22 (41%), multilevel left ventricular outflow tract obstruction in 20 (38%), and aortic valve stenosis or hypoplasia in 11 (21%). Before the Konno procedure, 66 operations were performed in 41 (77%) patients. Thirty-three (62%) patients had greater than New York Heart Association class I symptoms preoperatively. A mechanical aortic valve was implanted in 40 (75%), a homograft in 10 (19%), and a xenograft prosthesis in 3 (6%). Mortality at 30 days was 8% (n = 4). Survival at 10 years was 86%. Risk factors for overall mortality were New York Heart Association class (hazard ratio 2.22, P = .04) and longer bypass time (hazard ratio 1.93/hour, P = .04). The cumulative probability of aortic valve reoperation was 19% at 5 years and 39% at 10 years, occurring in 15 patients at a median of 3.8 years. The average left ventricular outflow tract mean gradients were 19 mm Hg at 1 year (n = 9), 13 mm Hg at 1 to 3 years (n = 9), and 13 mm Hg at 3 to 5 years (n = 5). Pulmonary regurgitation was detected in 6 patients. Pulmonary valve replacement was performed in 3 (6%). At the date of last contact, all patients for whom data was available were in New York Heart Association functional class I or II. Conclusion: The Konno procedure is effective, allowing both long-term reduction of left ventricular outflow tract obstruction and improvement in functional class. Prosthetic aortic valve and native pulmonary valve complications may necessitate reoperation.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume132
Issue number5
DOIs
StatePublished - Nov 2006

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Ventricular Outflow Obstruction
Aortic Valve
Pulmonary Valve
Reoperation
Pulmonary Valve Insufficiency
Mortality
Aortic Valve Stenosis
Heterografts
Prostheses and Implants
Allografts
Pathologic Constriction
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Long-term results of the Konno procedure for complex left ventricular outflow tract obstruction. / Suri, Rakesh M.; Dearani, Joseph A.; Schaff, Hartzell V; Danielson, Gordon K.; Puga, Francisco J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 132, No. 5, 11.2006.

Research output: Contribution to journalArticle

Suri, Rakesh M. ; Dearani, Joseph A. ; Schaff, Hartzell V ; Danielson, Gordon K. ; Puga, Francisco J. / Long-term results of the Konno procedure for complex left ventricular outflow tract obstruction. In: Journal of Thoracic and Cardiovascular Surgery. 2006 ; Vol. 132, No. 5.
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abstract = "Objective: This study was undertaken to determine long-term clinical and echocardiographic outcomes after the Konno procedure. Methods: Fifty-three patients who underwent the Konno procedure between January 1, 1980, and January 1, 2004, were reviewed. Results: Mean age at operation was 19 years (range, 1-65 years). Indications were as follows: complex subaortic or tunnel stenosis in 22 (41{\%}), multilevel left ventricular outflow tract obstruction in 20 (38{\%}), and aortic valve stenosis or hypoplasia in 11 (21{\%}). Before the Konno procedure, 66 operations were performed in 41 (77{\%}) patients. Thirty-three (62{\%}) patients had greater than New York Heart Association class I symptoms preoperatively. A mechanical aortic valve was implanted in 40 (75{\%}), a homograft in 10 (19{\%}), and a xenograft prosthesis in 3 (6{\%}). Mortality at 30 days was 8{\%} (n = 4). Survival at 10 years was 86{\%}. Risk factors for overall mortality were New York Heart Association class (hazard ratio 2.22, P = .04) and longer bypass time (hazard ratio 1.93/hour, P = .04). The cumulative probability of aortic valve reoperation was 19{\%} at 5 years and 39{\%} at 10 years, occurring in 15 patients at a median of 3.8 years. The average left ventricular outflow tract mean gradients were 19 mm Hg at 1 year (n = 9), 13 mm Hg at 1 to 3 years (n = 9), and 13 mm Hg at 3 to 5 years (n = 5). Pulmonary regurgitation was detected in 6 patients. Pulmonary valve replacement was performed in 3 (6{\%}). At the date of last contact, all patients for whom data was available were in New York Heart Association functional class I or II. Conclusion: The Konno procedure is effective, allowing both long-term reduction of left ventricular outflow tract obstruction and improvement in functional class. Prosthetic aortic valve and native pulmonary valve complications may necessitate reoperation.",
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AB - Objective: This study was undertaken to determine long-term clinical and echocardiographic outcomes after the Konno procedure. Methods: Fifty-three patients who underwent the Konno procedure between January 1, 1980, and January 1, 2004, were reviewed. Results: Mean age at operation was 19 years (range, 1-65 years). Indications were as follows: complex subaortic or tunnel stenosis in 22 (41%), multilevel left ventricular outflow tract obstruction in 20 (38%), and aortic valve stenosis or hypoplasia in 11 (21%). Before the Konno procedure, 66 operations were performed in 41 (77%) patients. Thirty-three (62%) patients had greater than New York Heart Association class I symptoms preoperatively. A mechanical aortic valve was implanted in 40 (75%), a homograft in 10 (19%), and a xenograft prosthesis in 3 (6%). Mortality at 30 days was 8% (n = 4). Survival at 10 years was 86%. Risk factors for overall mortality were New York Heart Association class (hazard ratio 2.22, P = .04) and longer bypass time (hazard ratio 1.93/hour, P = .04). The cumulative probability of aortic valve reoperation was 19% at 5 years and 39% at 10 years, occurring in 15 patients at a median of 3.8 years. The average left ventricular outflow tract mean gradients were 19 mm Hg at 1 year (n = 9), 13 mm Hg at 1 to 3 years (n = 9), and 13 mm Hg at 3 to 5 years (n = 5). Pulmonary regurgitation was detected in 6 patients. Pulmonary valve replacement was performed in 3 (6%). At the date of last contact, all patients for whom data was available were in New York Heart Association functional class I or II. Conclusion: The Konno procedure is effective, allowing both long-term reduction of left ventricular outflow tract obstruction and improvement in functional class. Prosthetic aortic valve and native pulmonary valve complications may necessitate reoperation.

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