Apicoaortic valved conduits for complex left ventricular outflow obstruction: technical considerations and current status.

The surgical considerations, clinical follow-up, and hemodynamic data for 23 patients (age range, 4 months to 80 years) who underwent insertion of a porcinevalved apicoaortic conduit between December, 1976, and June, 1983, are reviewed. All patients had complex forms of left ventricular outflow obstruction. All were symptomatic, and 18 had had 23 prior attempts at surgical relief of the obstruction. There was a total of 6 deaths (26%); 2 were in small children with other complex cardiac malformations, and 2 others in patients who required emergency operation for acute cardiac decompensation. Sixteen patients have had cardiac catheterization 1 to 1.5 years postoperatively, and a reduction in the resting left ventricular-aortic gradient from 91 +/- 30 to 13 +/- 8 mm Hg was demonstrated (p less than 0.001). None of the patients is taking anticoagulants, and no thromboembolic events have occurred. Four of the 17 survivors have undergone a subsequent operation 1.5 to 4.0 years postoperatively with conduit removal, aortoventriculoplasty, and conduit valve replacement in 1, 1, and 2 patients, respectively. These data demonstrate that the apicoaortic conduit is effective in relieving complex left ventricular outflow obstruction and improving left ventricular performance with acceptable long-term results. Increasing the durability of the conduit valve will greatly improve the late results with this technique.