Surgical treatment of various types of left ventricular outflow tract stenosis by aortoventriculoplasty--clinical results.

Abstract

Since 1974 the new concept of aortoventriculoplasty (AVP) has been applied clinically in Göttingen. Out of 1,112 patients with various types of congenital aortic stenosis 502 patients have undergone commissurotomy, resection of a subvalvular ring, myotomy and supravalvular patch plasty. Fifty-seven patients were treated by AVP, in only 11 patients was AVP the first procedure, 46 had had one or more previous operations. Total hospital mortality was 12.2%; in the last 37 cases there was only one death. Two patients suffered permanent AV block. The mean left ventricular-aorta gradient was reduced from 94 +/- 24 mmHg to 14 +/- 15 mmHg after AVP. In our clinical material the indications for AVP (n = 57) have been the following: valvular aortic stenosis with narrow annulus (8 patients), diffuse subaortic stenosis (20) (from collar-like to tunnel-like, out of these patients 6 with Shone-complex), multi-level stenosis (20), outgrown prosthesis (4), hypertrophic obstructive cardiomyopathy (5). In comparison to the apico-aortic conduit procedure and total replacement of the aortic root by homograft, the clinical results indicate AVP to be a simple and easy-to-apply operative technique.