THE KONNO–RASTAN PROCEDURE: RESULTS AND OUTCOMES IN CONGENITAL PATIENTS

Background and Aim: Konno-Rastan procedure involves enlargement of aortic annulus to accommodate larger prosthetic valve, improving hemodynamics and reducing patient-prosthesis mismatch. This study aims to evaluate mid-term and echocardiographic results. Methods: This study retrospectively examined outcomes in 21 patients, aged 5 to 49 years, between February 2015 and June 2023. Patients were followed for a median of 2.6 years (IQR:1-5 years). The primary outcomes assessed included survival rates, early morbidity, reintervention, mid-term results and echocardiographic status. Results: Median age was 23years (IQR:14-36.7), median BSA 1.67m 2 (IQR:1.46- 1.8). Eleven were female. Seventeen (81%) had previous procedures, including one balloon valvuloplasty. Average aortic annulus size was 18 mm, mean transvalvular gradient was 47mmHg.Mechanical valves were implanted in 20 patients, one patient receiving biological valve; the average size of the prosthetic valves was 21 mm. Three patients required concomitant surgical procedures. Median CPB time was 140 minutes (IQR:115-178), median aortic cross-clamp time was 110 minutes (IQR:91-138). There were no procedure-related mortalities, no patients experienced major arrhythmias or heart blocks postoperatively. Freedom from reintervention rate was 96% at both 1 year and 5 years and only one requiring a reoperation due to prosthetic valve detachment two months after the procedure for endocarditis. Mean transvalvular gradient at the most recent follow-up was 13mmHg. Conclusion: The Konno procedure is a highly effective option for patients with a small aortic annulus, offering encouraging long-term outcomes. Its strategic incisions optimize exposure and facilitate annulus enlargement, significantly improving hemodynamics. Procedure’s success highlights importance of precise surgical techniques to minimize complications, such as conduction system and coronary injuries, ensuring it remains a reliable choice for complex aortic valve replacements.