Aortic root enlargement may be necessary for a small aortic annulus to allow the implantation of a larger aortic valve prosthesis. Larger prostheses are associated with a lower incidence of patient prosthesis mismatch and lower rates of structural valve deterioration. Looking to the future, a larger aortic valve prosthesis will facilitate valve-in-valve aortic replacements by allowing the placement of a larger valve and decreasing the chances of coronary compromise. In this presentation, the authors describe the Nicks procedure, which enlarges the root by extending the aortotomy across the noncoronary sinus through the annulus into the anterior leaflet of the mitral valve.
Very good presentation and video.
In our experience, we had a patient who developed a new mitral regurgitation after 6 months of surgery, there being no other condition than the aortic annular enlargement with this Nicks technique. Because of this we prefer the Manouguian technique, which does not deeply involve the anterior leaflet of the mitral valve .
Replying to Alberto , what he describes is the Nunez technique and not the Manouguian, which is extended over the mitral valve.
I really appreciated your presentation and your video. I completely agree with George Stavridis for the definition of the Manouguian technique. I would like to ask him what are the respective indications of the Nunez and Mannouguian techniques?In our experience we used the Mannouguian technique by extending the incision on the large mitral valve and the roof of the left atrium.We used autologous pericardium renfocated on the aortic part by dacron to avoid the formation of false aneurysms of the aortic root.What’s your opinion?thanks for your help
Nice picture in this commentary: https://www.jtcvs.org/article/S0022-5223(08)00337-1/fulltext
Thanks to your generosity Dr Kelly Wanamaker
Replying to Dr. Brahami a Nunez technique usually allows you to implant a one size larger valve whilst the Manouguian two sizes. Needless to say may prove more cumbersome as you risk a mitral regurgitation.
thank you very much for your cooperation and your clarifications Dr Stavridis.
After this type of operation (Nicks, Manouguian), when you used a big piece of pericardium, aorta looks like non rigth with “ears” and that’s why I created a template shaped like boomerang and cut a patch from standart 4×6 sm xenopericardial band. And when we began to use this form of patch (boomerang) – the aorta began to look smooth and very natural.
thank you for this technical clarification Dear collegue Evgeny Rosseykin
Excellent presentation; superb video quality.
Only caveat gleaned from Dr.Lytle, avoid a redundant patch!