title: Apicoaortic conduit for left ventricular outflow tract obstruction: revisited.
abstract: BACKGROUND
  We have used a variety of techniques to correct left ventricular outflow tract obstructions, including, in the past, placement of an apicoaortic valved conduit to bypass the outflow tract. Because the operation was technically difficult, it had fallen into disuse. Recently, we used a simplified transthoracic approach to implant apicoaortic conduits in 7 patients with complex lesions of the left ventricular outflow tract.
  
  
  METHODS
  The thoracic cavity was entered through the fifth intercostal space in all 7 patients. The distal end of the valve-containing conduit was attached to the aorta with continuous 3-0 or 4-0 polypropylene sutures after incising the pleura over the distal descending aorta. The pericardium was opened to expose the left ventricular apex, which was cored so that the proximal end of the conduit could be inserted into the left ventricular cavity.
  
  
  RESULTS
  Five of the patients recovered completely. The 2 patients who died had severe heart disease and multiple comorbidities.
  
  
  CONCLUSIONS
  The transthoracic approach gives direct access to the descending aorta and avoids a redo sternotomy. The technique, which is simple to perform, does not compromise major coronary arteries, the conduction system, or other valves; and may be useful in patients who are not good candidates for other, more conventional procedures.
authors.affiliation: Texas Heart Institute at St. Luke's Episcopal Hospital, Houston 77225-0345, USA. dcooley@heart.thi.tmc.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Cooley
authors.forename: R M
authors.initials: RM
authors.lastname: Lopez
authors.forename: T S
authors.initials: TS
authors.lastname: Absi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000601:surgery*