The Ross/Konno procedure

The technique of aortic valve replacement with the pulmonary autograft was originally described by Ross in 1967. Aortoventriculoplasty was first described by Konno in 1975 and was used for aortic valve replacement using a mechanical prosthesis. Since then, various refinements in both procedures as well as wider availability of cryopreserved allografts have permitted increasing application of the combined surgical approach in infants and small children. The Ross-Konno combination became particularly appealing in the treatment of complex left ventricular tract obstruction that is often not amenable to simpler techniques such as open valvulotomy or balloon valvuloplasty. The Ross-Konno technique offers a number of advantages over the two alternatives of mechanical or allograft valve replacement. It has a low risk of thromboembolism and prosthetic valve endocarditis, and avoids the lifetime anti-coagulation requirement and the size limitation seen with the mechanical valves. It also seems to be free of the rapid degeneration observed with the allografts, particularly when placed in the aortic position. However, the primary advantage of the pulmonary autograft over the other two choices is its apparent potential for growth in the aortic position. Confirmed in a number of short to intermediate term follow-up studies, the Ross-Konno technique is at this time the superior option for definitive treatment of a complex LVOTO at an early age.