33440 Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (Ross-Konno procedure)

Name of the Procedure:

Ross-Konno Procedure
(Common name: Ross-Konno procedure, Medical terms: Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve.)

Summary

The Ross-Konno procedure involves replacing the diseased aortic valve with the patient's own pulmonary valve. The pulmonary valve is then replaced with a valved conduit. This complex surgery is used to treat severe or critical aortic valve conditions and related heart structure problems, often in children and young adults.

Purpose

• Medical Condition/Problem: Severe aortic valve disease including stenosis and regurgitation.
• Goals/Expected Outcomes: To provide a long-lasting valve solution, maintain natural heart function, improve blood flow, and enhance the patient’s quality of life.

Indications

• Severe aortic stenosis or insufficiency.
• Congenital heart defects affecting the aortic valve.
• Previously failed aortic valve replacements.
• Patient criteria: Typically younger patients who need durable valve solutions.

Preparation

• Pre-procedure Instructions: Fasting from midnight before surgery, blood tests, avoiding certain medications as advised by the doctor.
• Diagnostic Tests: Echocardiogram, cardiac MRI/CT, electrocardiogram (ECG), blood work, and chest X-ray.

Procedure Description

1. Anesthesia is administered to ensure the patient is unconscious and pain-free.
2. The chest is opened via a midline sternotomy.
3. The diseased aortic valve is removed.
4. The patient's pulmonary valve is excised and moved to the aortic valve position.
5. Enlargement of the aortic annulus is done via a transventricular approach.
6. A valved conduit is used to replace the pulmonary valve.
7. The heart and chest are then closed, and the patient is taken off the heart-lung machine.

Duration

Approximately 6-8 hours.

Setting

Performed in a hospital operating room, typically with a subsequent stay in an intensive care unit (ICU).

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist
• Intensive Care Team

Risks and Complications

• Common risks: Bleeding, infection, arrhythmias.
• Rare risks: Valve dysfunction, heart attack, stroke.
• Complications management: Continuous monitoring, medication adjustments, possible repeat surgery.

Benefits

• Natural valve performance in the aortic position.
• Long-term durability, especially favorable for young patients.
• Improved heart function and patient quality of life.

Recovery

• Post-procedure Care: ICU stay for close monitoring, pain management, respiratory therapy, gradual reintroduction to regular activity.
• Recovery Time: Initial hospital recovery of 1-2 weeks, full home recovery in 6-8 weeks.
• Restrictions/Follow-ups: Limited physical activity initially, follow-up appointments with cardiology and surgery teams.

Alternatives

• Mechanical valve replacement: Requires lifelong anticoagulation.
• Bioprosthetic valve replacement: May require future replacement due to wear.
• Balloon valvuloplasty: Temporary fix, often used in children.
• Each alternative has varying benefits regarding durability, need for anticoagulation, and ease of subsequent procedures.

Patient Experience

• During Procedure: The patient will be under general anesthesia, unaware of the surgery.
• Post-procedure: Discomfort or pain managed with medications, feelings of fatigue or weakness as recovery progresses.
• Pain Management: Pain relievers, both intravenous and oral, will be provided as needed.
• Comfort Measures: Gradual increase in physical activity, support from healthcare team for breathing exercises and mobility assistance.