Creation of double-outlet left ventricles for left ventricular outflow obstructions: initial clinical results in six patients.

Operations for supravalvular, valvular, and subvalvular stenoses are frequently complicated by aortic insufficiency, recurrence, or aortic valve prosthetic malfunction. Without surgery, increasing left ventricular pressures, myocardial hypertrophy, congestive failure, and sudden death are common. Following an extended series of bovine experiments, we have created double-outlet left ventricles in 6 patients. All but one had been operated on previously for combined supravalvular, valvular, or subvalvular aortic stenosis or idiopathic hypertrophic subaortic stenosis. All left ventricular-ascending aortic gradients were markedly decreased and the deranged left ventricular physiologic indices returned toward normal following operation and discharge from the hospital. None of these patients is receiving Coumadin, and none has exhibited any deleterious effects from the fractionation of left ventricular output, cephalad and caudad. Our current prosthesis is a composite consisting of a special LTI carbon inlet tube with a left ventricular apical sewing ring and graft extension anastomosed to a Hancock prosthesis of appropriate size. The procedure is simple, reproducible, effective, and has much to recommend. Special conduits are now being fabricated for future use. In certain instances, this approach may have advantages over conventional primary aortic valvotomy in infants or valve replacement in adults.