Technique for simultaneous aortic root replacement and Konno aortoventriculoplasty (Bentall-Konno)

Abstract

Aortic valve patient-prosthesis mismatch is associated with unfavorable outcomes. There are several techniques to mitigate this. Occasionally, root replacement may be required in the context of small aortic annuli or hypoplastic left ventricular outflow tract (LVOT). For children or young adults, the Ross operation (± Konno aortoventriculoplasty) may constitute a satisfactory solution. However, most adults, particularly those older than 50 years, may not be considered candidates for the Ross operation, particularly if associated annular enlargement is needed. In clinical practice, a subgroup of patients requiring root replacement present with the need for simultaneous LVOT/annular enlargement who can benefit from an aortoventriculoplasty (Bentall-Konno). Through this modified Konno procedure, a larger prosthesis can be implanted. This option is of interest when an anterior root enlargement is prioritized, as in cases of hypoplasia of the LVOT. The technique could be especially useful in patients presenting with a normal functioning mitral prosthesis, when seeking a durable mechanical prosthetic substitute, and in patients with debilitated anterior aortic annuli (endocarditis with anterior invasion or anterior annular defects consequence of or multiple prior interventions). The use of two unified patches anchored with interrupted stitches simplifies the operation, provides a platform for root conduit anchorage, and allows appropriate right ventricular outflow tract reconstruction. We provide a detailed description of the technique, present two videos from different patients, and supplement this material with a wet lab model to facilitate safe adoption of this approach.