How to Perform the Konno-Rastan Aortic Root Enlargement Procedure

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The Konno–Rastan procedure, also known as anterior aortoventriculoplasty, is a well-established technique for aortic valve replacement with annulus enlargement. First described by Rastan and Koncz and also by Konno et al. in 1976 for treating tunnel-like subaortic stenosis (1, 2), this procedure effectively addresses subvalvar, valvar, and supravalvar stenosis. 
 
By performing the Konno–Rastan procedure, surgeons can relieve obstruction and stenosis along the left ventricular outflow tract (LVOT) up to the ascending aorta, while also allowing the implantation of a prosthetic valve significantly larger than the native annulus—even in small children. 
 
Compared to other annular enlargement techniques, such as Nicks, Manouguian, and the more recently introduced Yang procedure, the Konno–Rastan technique offers a key advantage: it effectively alleviates the subvalvar component of obstruction, which is particularly critical in pediatric cases. 
 
This surgical video demonstration illustrates the step-by-step technique for performing the Konno–Rastan procedure, highlighting essential details, technical nuances, and potential pitfalls to ensure optimal outcomes. 

References

1. Rastan H, Koncz J. Aortoventriculoplasty: a new technique for the treatment of left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg 1976;71:920–7.
2. Konno S, Imai Y, Iida Y, Nakajima M, Tatsuno K. A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring. J Thorac Cardiovasc Surg 1975;70:909–17.

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