How-I-Do-It: Aortic Annular Enlargement - Are the Nicks and Manouguian Obsolete?

The Y-incision aortic annular enlargement (AAE), first performed in August 2020, offers a safe and more effective alternative for management of a small aortic annulus/root without need for violation of the left ventricular outflow tract, mitral valve geometry, or left/right atria in both first-time...

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Bibliographic Details
Published in:Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual 2024, Vol.27, p.25-36
Main Authors: Hassler, Kenneth R., Monaghan, Katelyn, Green, China, Yang, Bo
Format: Article
Language:English
Subjects:
Aged
aortic root enlargement
Aortic stenosis
Aortic Valve - diagnostic imaging
Aortic Valve - surgery
Aortic Valve Stenosis - surgery
Endocarditis - surgery
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Male
Manouguian procedure
Middle Aged
Nicks procedure
Renal Dialysis
small aortic root/annulus
Y-Incision aortic annular/root enlargement
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Summary:The Y-incision aortic annular enlargement (AAE), first performed in August 2020, offers a safe and more effective alternative for management of a small aortic annulus/root without need for violation of the left ventricular outflow tract, mitral valve geometry, or left/right atria in both first-time aortic valve replacement (AVR) and reoperative AVR. In the first consecutive 119 patients with Y-incision AAE, the median age was 65 (59, 71), 67% female, 28% had previous cardiac surgery, and 2 cases had endocarditis. The preoperative mean gradient was 36 (30, 47), and the native aortic valve area was 0.9 (0.7, 1.0). After aortic annular enlargement, the median prosthesis size was 29 (27, 29) with 63% of patients having a size 29 or the largest sized valve. The median increment of annulus enlargement was 3 (3, 4) valve sizes. Postoperative complications included 1 operative mortality, 1 stroke exacerbation, and 2 pacemaker implantations (including one case of endocarditis with Gerbode fistula). There was no renal failure requiring permanent dialysis, mediastinitis, or reoperation for bleeding. Postoperative computed tomography aortogram showed the aortic root was enlarged from 27 (24, 30) to 40 (37, 42) mm without aortic pseudoaneurysm. The postoperative mean gradient was 6 (5, 9) mm Hg and valve area was 2.2 (1.8, 2.6) cm2 at 24 months. Mitral and tricuspid valve functions were significantly improved. This report describes the Y-incision technique with the most up-to-date modifications and short-term outcomes.
ISSN:1092-9126
DOI:10.1053/j.pcsu.2023.12.005