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Management of Complex Left Ventricular Outflow Tract Obstruction: A Comparison of Konno and Modified Konno Techniques

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Abstract

Management of complex left ventricular outflow tract obstruction (LVOTO) can be achieved with a Konno or Modified Konno procedure to enlarge the LVOT. We hypothesized that patients who undergo a Modified Konno procedure would have a higher rate of LVOT re-intervention compared to the Konno procedure. Patients who underwent a Konno or Modified Konno procedure for LVOTO at a single tertiary care center between 1990 and 2014 were retrospectively reviewed. The primary outcome was LVOT re-intervention post-discharge from index Konno or Modified Konno procedure. Cox regression and Kaplan–Meier estimates were used for time-to-event analysis of LVOT re-interventions, any unplanned re-interventions, and transplant-free survival. The study included 122 patients: 51 (41.8%) in the Konno group and 71 (58.2%) in the Modified Konno group. Median age at surgery was 8.2 (IQR 3–16) years in the Konno group and 3.9 (IQR 1.5–11) years in the Modified Konno group. Multiple left heart lesions were less prevalent in Modified Konno patients. There were 36 (29.5%) patients with LVOT re-interventions: 8 (16%) in the Konno group and 28 (39.4%) in the Modified Konno group (p = 0.01). Transplant-free survival at five years was 87.2% for the Konno group and 93.5% for the Modified Konno group. A higher rate of LVOT re-intervention was found in the Modified Konno group although the Konno and Modified Konno techniques were applied to different patient populations. This finding suggests that careful preoperative decision-making can direct therapy appropriately and that fundamental diagnosis affects procedure choice.

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Correspondence to Meena Nathan.

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Supplemental Fig. 5 Time from index surgery to LVOT re-intervention based on age at index surgery Electronic supplementary material 10 (TIF 82 kb)

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Electronic supplementary material 11 Supplemental Fig. 6 Time from index surgery to death based on age at index surgery (TIF 68 kb)

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Electronic supplementary material 2 Supplemental Fig. 7 Box plot comparing age at index surgery for Konno and Modified Konno groups (TIF 49 kb)

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Electronic supplementary material 3 Supplemental Fig. 8 Kaplan–Meier curve for the composite outcome of mortality/transplant or LVOT re-intervention post-index surgery for Konno or Modified Konno groups (TIF 88 kb)

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Haider, M., Carlson, L., Liu, H. et al. Management of Complex Left Ventricular Outflow Tract Obstruction: A Comparison of Konno and Modified Konno Techniques. Pediatr Cardiol 42, 614–627 (2021). https://doi.org/10.1007/s00246-020-02522-9

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  • DOI: https://doi.org/10.1007/s00246-020-02522-9

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