Pechenenko Anton, Mestres Carlos A, Sandoval Elena, Ascaso María, Konodiuk Maksym, Quintana Eduard
Cardiovascular Surgery Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
Cherkasy Regional Cardiology Center, Cherkasy, Ukraine.
Asian Cardiovasc Thorac Ann. 2025 Mar;33(2-3):161-163. doi: 10.1177/02184923251332978. Epub 2025 Apr 10.
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.
主动脉瓣患者-人工瓣膜不匹配与不良预后相关。有多种技术可减轻这种情况。偶尔,在主动脉瓣环较小或左心室流出道(LVOT)发育不全的情况下可能需要进行根部置换。对于儿童或年轻成人,罗斯手术(± 康诺主动脉心室成形术)可能是一个令人满意的解决方案。然而,大多数成年人,尤其是50岁以上的成年人,可能不被认为是罗斯手术的候选人,特别是如果需要进行相关的瓣环扩大。在临床实践中,一部分需要进行根部置换的患者同时需要扩大LVOT/瓣环,他们可以从主动脉心室成形术(本塔尔-康诺手术)中受益。通过这种改良的康诺手术,可以植入更大的人工瓣膜。当优先考虑扩大前根部时,如LVOT发育不全的情况,这种选择很有意义。该技术在二尖瓣人工瓣膜功能正常、寻求耐用的机械人工瓣膜替代物的患者以及主动脉前瓣环衰弱(心内膜炎侵犯前部或前部瓣环缺损是先前多次干预的结果)的患者中可能特别有用。使用两个用间断缝线固定的统一补片简化了手术,为根部管道固定提供了平台,并允许进行适当的右心室流出道重建。我们详细描述了该技术,展示了来自不同患者的两个视频,并用湿实验室模型补充这些材料,以促进安全采用这种方法。