From the Guidelines
The Ross-Konno procedure is a complex cardiac surgery that combines the Ross procedure with the Konno aortoventriculoplasty to treat certain congenital heart defects, primarily performed on children with left ventricular outflow tract obstruction and aortic valve disease. This operation involves removing the patient's own pulmonary valve (autograft) and using it to replace the diseased aortic valve, then enlarging the removed aortic valve area by cutting into the ventricular septum (the Konno portion), which relieves any obstruction below the valve. A pulmonary homograft (donor valve) is then used to replace the patient's original pulmonary valve, as described in the 2020 ACC/AHA guideline for the management of patients with valvular heart disease 1.
The benefits of the Ross-Konno procedure include the potential for the patient's own pulmonary valve to grow with a child, reducing the need for future valve replacements, and eliminating the need for lifelong anticoagulation therapy that mechanical valves would require. However, the procedure is technically demanding and requires significant expertise, with potential risks including valve degeneration and the need for reintervention, as noted in the guideline 1.
Key considerations for the Ross-Konno procedure include:
- Patient age and anatomy
- Tissue characteristics
- Contraindications to anticoagulation
- The need for a Comprehensive Valve Center with experienced surgeons
- The potential for excellent hemodynamic results and improved quality of life for patients with complex left ventricular outflow tract obstructions, as supported by the guideline recommendations 1.
The Ross-Konno procedure should be considered for patients with appropriate anatomy and tissue characteristics, particularly those who are younger and may benefit from avoiding anticoagulation and prosthetic heart valves, as suggested by the guideline 1.
From the Research
Definition of Ross-Konno Procedure
- The Ross-Konno procedure is a surgical operation used to treat complex left ventricular outflow tract obstruction, including hypoplastic aortic anulus with or without severe diffuse subaortic stenosis 2.
- It involves the use of a pulmonary autograft to replace the aortic valve and enlarge the left ventricular outflow tract 2, 3.
Indications and Outcomes
- The procedure is often performed in young patients, including infants, children, and adolescents, with congenital left ventricular outflow tract abnormalities 3, 4.
- Studies have shown that the Ross-Konno procedure is associated with substantial early mortality and gradual attrition thereafter, with higher mortality rates in patients with concomitant mitral valve surgery 4.
- The procedure has been shown to have good long-term outcomes, with low rates of autograft regurgitation and homograft degeneration 3.
Surgical Technique
- The Ross-Konno procedure involves the replacement of the aortic root with a pulmonary autograft valve, and the enlargement of the left ventricular outflow tract using a patch or extension 2, 5.
- The procedure can be performed with or without concomitant mitral valve surgery, and may involve the resection of endocardial fibroelastosis 4, 5.
Comparison with Other Procedures
- The Ross-Konno procedure is one of several surgical options available for the treatment of left ventricular outflow tract abnormalities, including the Ross operation, the Konno-Rastan operation, and the modified Konno operation 5.
- The choice of procedure depends on the individual patient's anatomy and pathology, as well as the surgeon's preference and experience 5.