[Aortic root enlargement in elderly patients]

Area of Science:

• Cardiovascular Surgery
• Geriatric Cardiology
• Cardiac Valve Disease

Context:

• Severe aortic stenosis poses significant risks, especially in elderly patients.
• The small aortic annulus in elderly patients presents surgical challenges.
• The Nicks procedure offers a potential solution for aortic root enlargement (ARE).

Purpose:

• To evaluate the safety and efficacy of the Nicks procedure for aortic root enlargement (ARE) in elderly patients with severe aortic stenosis.
• To assess the impact of ARE on cardiac function, ventricular mass, and clinical outcomes.
• To compare ARE alone versus combined procedures in this patient population.

Summary:

• Twelve elderly patients (mean age 79.3) with severe aortic stenosis underwent ARE using the Nicks procedure.
• No deaths occurred; significant improvements were observed in cardiothoracic ratio, NYHA functional class, peak pressure gradient, and left ventricular mass index (LVMI).
• ARE alone showed a favorable safety profile compared to combined procedures, with comparable echocardiographic results.

Impact:

• The Nicks procedure is a safe and effective option for elderly patients with severe aortic stenosis and small aortic annulus when performed without concomitant procedures.
• Demonstrates significant regression of left ventricular mass and improvement in cardiac function post-operatively.
• Highlights the importance of considering ARE as a standalone procedure to minimize risks in this vulnerable population.