Name of the Procedure:

Replacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure)

Summary

The Konno procedure is a cardiac surgery aimed at replacing the aortic valve and enlarging the aortic annulus, which is the ring of tissue from which the aortic valve leaflets originate. This procedure is performed via an incision through the wall of the heart (transventricular approach).

Purpose

The Konno procedure is designed to treat severe aortic stenosis (narrowing of the aortic valve) and is often used when the aortic annulus is too small for standard valve replacement. The goals are to improve blood flow from the heart, relieve symptoms like chest pain and shortness of breath, and prevent heart failure.

Indications

• Severe aortic stenosis or aortic valve disease
• Small aortic annulus not suitable for standard valve replacement
• Patients with congenital heart defects
• Symptoms such as fatigue, fainting, and difficulty breathing during activities

Preparation

• Fasting for at least 8 hours before surgery
• Medication adjustments as directed by the doctor
• Preoperative diagnostic tests like echocardiogram, coronary angiography, and blood tests

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A midline incision is made in the chest to access the heart.
3. Heart-Lung Machine: The patient is placed on a cardiopulmonary bypass machine to circulate blood and oxygen during the procedure.
4. Transventricular Approach: An incision is made in the ventricular wall to access the aortic valve.
5. Valve Replacement: The diseased aortic valve is removed and replaced with a new valve.
6. Annulus Enlargement: The opening of the aortic annulus is surgically enlarged to accommodate the new valve.
7. Closure: The ventricular wall and chest are closed, the heart is restarted, and the patient is taken off the bypass machine.

Duration

The procedure typically takes 4 to 6 hours.

Setting

The procedure is performed in a hospital operating room, often in a specialized cardiac surgery unit.

Personnel

• Cardiac surgeon
• Surgical assistants
• Anesthesiologist
• Perfusionist (operates the heart-lung machine)
• Scrub and circulating nurses

Risks and Complications

• Common risks: Infection, bleeding, arrhythmias
• Rare risks: Stroke, heart attack, valve malfunction, need for reoperation

Benefits

• Improved blood flow and heart function
• Relief from symptoms like chest pain and shortness of breath
• Increased activity tolerance and quality of life

Recovery

• Hospital stay of 7 to 10 days, including time in ICU
• Pain management with prescribed medications
• Gradual return to normal activities within 6 to 8 weeks
• Follow-up appointments for monitoring and possibly cardiac rehabilitation

Alternatives

• Balloon valvuloplasty (temporary relief)
• Transcatheter aortic valve replacement (TAVR) for select patients
• Medical management with medications to relieve symptoms

Patient Experience

• General anesthesia ensures no awareness during the procedure.
• Postoperative pain and discomfort managed with medications.
• Fatigue and soreness during recovery.
• Support from healthcare team for a smooth recovery process.