Konno aortic valve replacement in adults: Enabling larger prosthetic valve implantation and adequate aortic root enlargement for coronary clearance.

OBJECTIVE: Surgical aortic valve replacement in patients with severe aortic stenosis and small annuli remains challenging owing to prosthesis-patient mismatch and the limited feasibility of subsequent valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). The Konno procedure enables annular and left ventricular outflow tract (LVOT) enlargement; however, outcomes in adults remain insufficiently defined. METHODS: Between January 2023 and October 2025, 193 patients underwent surgical aortic valve replacement at our institution, of whom 19 (10%) received the Konno procedure for annulus diameter ≤19 mm, high likelihood of prosthesis-patient mismatch, or anticipated ViV-TAVR with estimated high risk of coronary obstruction. Operative results, echocardiographic and electrocardiographic parameters, and computed tomography measurements of the aortic root were assessed before and after surgery. RESULTS: Patients were aged 59 ± 19 years and 84% were women. Bioprostheses were implanted in 12 patients (63%) and mechanical valves in seven (37%), with enlargement permitting prosthesis implantation 2 to 3 sizes larger. Septal myectomy was performed in 6 patients. No in-hospital mortality occurred. Computed tomography demonstrated enlargement of the sinus of Valsalva (+7.0 mm) and sinotubular junction (+6.9 mm), consistent with ViV-TAVR feasibility. Echocardiography confirmed relief of LVOT obstruction; however, right ventricular diameter tended to increase, tricuspid annular plane systolic excursion declined, and QRS duration increased from 90 to 114 milliseconds, indicating intraventricular conduction delay. CONCLUSIONS: Konno aortic valve replacement facilitates implantation of larger prostheses, relieves LVOT obstruction, and optimizes root anatomy for future ViV-TAVR. Conduction disturbances and right ventricular functional decline warrant long-term surveillance.