This surgical video demonstrates they key steps, safeguards, and pitfalls of a Konno-Rastan aortoventriculoplasty. The patient underwent a fifth redo sternotomy after a complicated previous surgical history. In addition, previous percutaneous plugs had been used to treat a previous pseudoaneurysm located immediately under the aortic valve annulus. The pseudoaneurysm protruded into the transverse sinus causing external compression to the proximal left anterior descending artery (LAD). This was clinically symptomatic with the patient presenting with intermittent chest pain. Therefore, the patient required coronary bypass in combination with aortic valve interventions.
Key Surgical Considerations
This video highlighted careful operative planning, including defining the surgical objectives, selecting the appropriate valve size while avoiding oversizing, technique, and developing a safe strategy for chest reentry. It also demonstrated the management of existing percutaneous plugs, technically sound annular enlargement, and excision of a self-expanding transcatheter valve without distal exposure (through the valve as opposed to from above). Additionally, key points included identifying the anatomical landmarks for the Konno aortoventriculoplasty incisions, anatomical landmarks for left and right ventricular wall transitioning into the aorta, and applying safeguards to avoid bleeding at this location.
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