Posterior aortoventricular enlargement of root and outflow tract: Early and mid-term results

Abstract

Objective: Congenital hypoplasia of the left ventricular outflow tract (LVOT) and aortic annulus is a challenging problem. We have developed a novel posterior en largement technique that avoids a septal and right ventricular incision while effec tively enlarging the LVOT and aortic annulus. Here we report mid-term results with the use of this technique. Methods: Between 2011 and 2023, 5 patients (3 males [60%]; mean age, 28 ± 23 years) underwent posterior aortoventricular enlargement. The aortic valve and root were replaced by an autograft (n = 4) or a stentless porcine prosthesis (n = 1). Results: There were cases of no early death, myocardial infarction, neurologic complications, or permanent pacemaker implantation. One patient died 3 years postoperatively in a traffic accident, and 1 patient required pulmonary conduit reoperation for infective endocarditis 6.5 years postoperatively. Freedom from cardiac death and aortic valve or root reoperation was 100% at 10 years. Two patients had AR 1 at discharge, and 3 patients had AR 1 at last follow-up, between 12.1 and 13.4 years postoperatively, including the 2 with AR 1 at discharge. Median LVOT diameter was 12 mm preoperatively (interquartile range [IQR], 9.5-12.6 mm), 20 mm (IQR, 20-21 mm) at discharge, and 20 mm (IQR, 20-21 mm) at last follow-up. Median annular diameter was 17 mm (IQR, 15 18 mm) preoperatively, 21 mm (IQR, 20-22 mm) at discharge, and 25 mm (IQR, 24-26 mm) at last follow-up. Median LVOT gradient was reduced from 50 mm Hg (IQR 41-57 mm Hg) preoperatively to 9 mm Hg (IQR, 7-16 mm Hg) at discharge. All patients remained in sinus rhythm with normal PR intervals and QRS complexes. Conclusions: Posterior aortoventricular enlargement combined with root replacement yields effective relief of LVOT and annular hypoplasia. It appears to be a durable option for younger and older patients alike. (JTCVS Techniques 2026;35:102118)