The Konno-Rastan Procedure in the Current Era: Still A Feasible Option?

Abstract

Introduction: The Konno-Rastan procedure is a commonly used surgical technique to address complicated subaortic stenosis and to enlarge the aorta via an anterior route. The objective of this report is to describe the experience of our unit with this procedure.

Methods: Between 2002 and 2022, we identified pediatric patients who underwent the Konno-Rastan procedure. Relevant information was retrospectively collected.

Results: There were 16 patients who underwent the Konno-Rastan procedure. The median follow-up was nine years (4 - 16 years), and there was no operative mortality. All patients had a straightforward recovery, and five patients required reoperation at follow-up, none of which was related to the left ventricular outflow tract. The median echocardiographic indices at the most recent follow-up were not significantly different from the preoperative values, with a median peak gradient across the left ventricular outflow tract of 25 mmHg. In their most recent follow-up, 81% of the patients were New York Heart Association class 1. No bleeding, thromboembolic, or infective complications were encountered.

Conclusion: We concluded that the Konno-Rastan procedure can be regarded as a definitive alternative to other surgical interventions for left ventricular outflow tract obstructions. Although reoperations are still necessary, particularly in patients with additional mitral valve disease, the Konno-Rastan procedure is still a viable option in patients with complex left ventricular disease.

Keywords: Aorta; Hear Valve Diseases; Hypertrophic Cardiomyopathy; Left Ventricular Outflow Obstruction; Mitral Valve; Pathologic Constriction; Subvalvular Aortic Stenosis.

Fig. 1

Kaplan-Meier curves for freedom from death (A) and reoperation (B).

Fig. 2

Change in ejection fraction (EF) (%) (A) and fractional shortening (FS) (%) (B) of individual patients before Konno operation and at the last follow-up.