Early evaluation of the aortic root after Nicks' procedure

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Aortic Valve Surgery

Background:

• Aortic valve replacement (AVR) can be challenging in patients with small aortic annuli.
• Aortic root enlargement (ARE) techniques aim to improve outcomes and prevent complications.
• Ensuring the long-term stability and safety of ARE is crucial for patient prognosis.

Purpose of the Study:

• To evaluate the influence of surgical techniques on ARE during AVR.
• To assess the prevention of suture line disruption, leakage, and patch issues.
• To determine the long-term stability and safety of ARE, including aneurysm formation.

Main Methods:

• A retrospective study of 115 patients undergoing AVR or combined AVR and mitral valve replacement with Nicks' posterior ARE.
• Long-term echocardiographic and angio-computed tomographic evaluation.
• Aortotomy closure using autologous pericardial patch and Teflon-buttressed sutures.

Main Results:

• Low hospital mortality (1.7%) and acceptable late mortality.
• High survival probability (93.25%) at a mean follow-up of 123 months.
• No severe prosthesis-patient mismatch (PPM), minimal moderate PPM, and no late pericardial patch aneurysms.

Conclusions:

• ARE is a safe and effective adjunct to AVR in patients with small aortic annuli, preventing PPM.
• Pericardial collar retention and Teflon-buttressed sutures effectively reduce bleeding.
• Autologous pericardial patch aortoplasty is not associated with late aneurysm or pseudoaneurysm formation.