Repair of complex left ventricular outflow tract obstruction with a pulmonary autograft.

The surgical relief of complex multilevel left ventricular outflow tract (LVOT) obstruction remains a challenging surgical problem. We present a new operation which combines the concepts of aortoventriculoplasty, extended aortic root replacement and the use of a pulmonary autograft. Sixteen patients underwent this operation: 11 patients after previous attempts to relieve diffuse subvalvular stenosis and five patients who presented excessive gradients over an outgrown aortic valve prosthesis. All patients, except one survived the operation. One patient developed massive right ventricular infarction and was transplanted after five days. Another patient developed complete heart block and transient tricuspid regurgitation after a septal infarction. One patient remained in congestive heart failure and died suddenly after 17 months. All other patients are in NYHA class I after a mean follow up of 21 +/- 12 months. One patient developed progressive dilatation of the neo-aortic root and was reoperated four years after initial surgery. All other patients showed laminar flow in the LVOT and excellent function of the autograft and homograft valve at follow up. This operation might present a durable or even a definitive solution in the management of these complex left ventricular outflow tract obstructions.