الفهرس 
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Abstract
Introduction: The surgical management of complex left ventricular outflow tract (LVOT) obstruction has developed over three decades, and it continues to undergo further development. The Konno procedure is often considered as a final available option after initial attempts with less invasive catheter-based or surgical techniques fail to relieve left ventricular outflow tract obstruction. This procedure is associated with significant reduction in LVOTO gradient, stabilization of left ventricular function, and improvement in function class.
Aim: The aim of this review is to go through the literature to study the effectiveness, advantages, disadvantages and long-term outcome of Konno procedure in management of left ventricular outflow tract obstruction in children, and to review its modifications and other surgical options for management of left ventricular outflow tract obstruction.
Methods: This systematic review is reported following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) extension statement. We conducted a search of Medline from 1999. We also performed a grey literature search and checked reference lists of relevant reviews ensure a comprehensive search. Studies were eligible for inclusion if they consisted of patients (<18 years) who underwent Konno Procedure as a primary or secondary intervention. We excluded the studies of the modified Konno procedure and the Ross-Konno Procedure, and if there was another procedure combined with the Konno procedure. We also excluded case reports and studies of group size less than 10 participants.
Results: Our search identified 61 citations published between 1999 and 2019. We included 9 retrospective articles that are related to 8 study groups including 266 patients who underwent Konno procedure. group size ranged from 15 to 63 patients and ages ranged from 5 days to 34 years. The duration of follow up extended up to 18.5 years. Early mortality rate was 25 (9%) and late was 30 patients. Operative mortality has declined over the recent years with increased experience of the procedure. 24 patients had complete heart block.
Conclusion: The Konno Procedure is effective and safe for the treatment of complex LVOTO and for the preservation of ventricular function. However, the mortality and morbidity rates remain high which may require reoperation. In infants and children who are receiving a small sized prosthesis, the gradient over the prosthesis is increasing over time, which will inevitably lead to a reoperation later in life. In these patients, Ross-Konno procedure might be a better option.