Surgical Management of Aorto-Ventricular Tunnel. A Multicenter Study

• Published in: Seminars in thoracic and cardiovascular surgery 2020-01, Vol.32 (2), p.271-279
• Main Authors: Protopapas, Eleftherios M., Anderson, Robert H., Backer, Carl L., Fragata, José, Hakim, Nicolas, Vida, Vladimiro L., Sarris, George E., Barron, David J., Berggren, Håkan, Hazekamp, Mark G., Ilyin, Vladimir, Kornoukhov, Oleg J., Kostolny, Martin, Lazarov, Stojan, Lo Rito, Mauro, Monge, Michael C., Mykychak, Yaroslav, Nosal, Matej, Prêtre, René, Polimenakos, Anastasios C., Sojak, Vladimir, Stellin, Giovanni, Veshti, Altin, Yemets, Illya
• Format: Article
• Language: English
• Subjects: Aorto-ventricular tunnel; Surgical treatment
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2020.01.011

Aorto-ventricular tunnel (AoVT), a rare congenital anomaly, is a channel originating in the ascending aorta just above the sinotubular junction and leading to the cavity of the left ventricle (AoLVT), or, rarely, the right (AoRVT). This study reviews our collective 30-year experience with the surgical treatment of AoVT. Data were submitted by 15 participating centers on 42 patients who underwent correction of AoVT between 1987 and 2018. Of these, 36 had AoLVT, and 6 AoRVT. The tunnel originated above the right coronary sinus in 28 (77.8%) patients. For AoLVT, most operations were performed early (median age 25 days, range: 1 day–25 years). In contrast, AoRVT was diagnosed and repaired later (median age 6 years, range: 1 month–12 years). Surgically important coronary ostial displacement was common. Patch closure of the aortic orifice only was the commonest surgical repair for AoLVT (23 patients), while in AoRVT, both orifices or only the ventricular one was closed. Aortic valvar insufficiency, severe or moderate, coexisted in 11 (30.5%) patients with AoLVT, and aortic valvuloplasty was performed in 8, mainly due to aortic valve stenosis. Aortic valvar insufficiency at discharge ranged from trivial to mild in almost all patients. Early mortality was 7.14%, with 3 patients with AoLVT succumbing to cardiac failure. There were 2 early reoperations and 1 late death. AoVT is a rare malformation. AoLVT usually necessitates surgery in early life. AoRVT is rarer, diagnosed and repaired later in life. Surgical repair by patch closure, with concomitant aortic valve repair as needed, is associated with good results. A retrospective multicenter study focused on the surgical treatment of aorto-ventricular tunnel (AoVT), analyzing outcome of 42 patients. AoVT usually originates above right coronary sinus (RCS) terminating either in the left ventricle (aorto-left ventricular tunnel—AoLVT), or in the right ventricle (aorto-right ventricular tunnel—AoRVT). Surgical closure with patch must be accomplished without distortion of ostium of right coronary artery (RCA) or the aortic valve. Frequent concomitant aortic valve pathology should also be appropriately addressed. [Display omitted]