Konno Procedure for Managing Small Aortic Root during Aortic Valve Replacement Surgery: An Experience of 12 Cases

Abstract

Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period.

Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. A retrospective Comparative cohort study

“…Patient′s age and activity can be considered for calculating cardiac output demand; young people with active life style will require larger prostheses for a higher cardiac demand. Since implanting a small-sized valve can worsen outcome due to increased preload [2]. This study was undertaken to review our strategy and feasibility of ARE in patient underwent DVR to avoid PPM without increase in morbidity or mortality especially in young patients (age 45± 10).…”

“…With undersized prosthetic valve, patient can't maintain normal activity; produce symptoms of aortic stenosis (AS) and PPM. Rahimtola rst described the issue of PPM, if the EOA of prosthetic valve is very small in relation to patient′s BSA [1][2]. Nicks and colleagues rst proposed posterior root enlargement in 1970.…”

“…When ARE is performed properly by an experienced cardiac surgeon, it is safe and reproducible [8]. So, nowadays surgeons prefer to do ARE to get rid of PPM and to obtain optimum hemodynamics [1][2].…”

Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. A retrospective Comparative cohort study.

“…With undersized prosthetic valve, patient can't maintain normal activity; produce symptoms of aortic stenosis (AS) and PPM. Rahimtola first described the issue of PPM, if the EOA of prosthetic valve is very small in relation to patient's BSA [1][2] . Nicks and colleagues first proposed posterior root enlargement in1970.…”

“…Performed properly by an experienced cardiac surgeon, the technique is safe and reproducible [8]. So, nowadays surgeons prefer to do ARE to get rid of PPM and to obtain optimum hemodynamics [1][2]. Methods Demographic, intraoperative, and outcome data were collected retrospectively cohort comparative study on (100) patients undergoing DVR with or without ARE at a multicenter institutions between Jan. 2016 -Sept. 2020.…”