Posterior aortic root enlargement (Nick's procedure), mechanical aortic valve replacement and patch closure of the sacciform proximal aortic arch aneurysm by open technique without circulatory arrest: a video presentation

Chowdhury, Ujjwal K.; Sankhyan, Lakshmi Kumari; George, Niwin; Singh, Sukhjeet; Gayatri, Sushama; Avneesh, Sheil; Malik, Vishwas; Chowdhury, Priyanka

doi:10.5455/im.302644647

Cited by 2 publications

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“…The surgical risk of this procedure includes injury to the septal perforators, conduction system, and places the patient at risk of intracameral fistulae. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 …”

Section: Discussionmentioning

confidence: 99%

“…In this study population, 78 (67.8%) patients underwent standard Nicks' procedure of ARE and 37 (32.2%) patients underwent modified Nicks' procedure on an individualized basis. 7 , 9 , 17 , 19 The technical details of both techniques have been addressed in our previous publications. 17 , 19 The most significant preoperative patient characteristics are summarized in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

“… 7 , 9 , 17 , 19 The technical details of both techniques have been addressed in our previous publications. 17 , 19 The most significant preoperative patient characteristics are summarized in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

“… 15 , 16 To address these concerns, the corresponding author has been retaining a pericardial collar at the site of enlarged ventriculoaortic junction and Teflon-buttressed monofilament polypropylene sutures to avoid suture line disruption, thus ensuring perfect hemostasis ( Figure 1 ). 17 The primary aim of the study was to assess the influence of the surgical technique adopted to avoid suture line disruption, paraprosthetic leakage, aortic dissection, and patch dislodgement.

Figure 1 Graphic display (n = 115) showing pericardial collar and Teflon-buttressed sutures at the ventriculo-aortic junction with no aneurysm/pseudoaneurysm formation.…”

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confidence: 99%

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Early evaluation of the aortic root after Nicks' procedure

et al. 2020

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Objective(s) To determine the influence of surgical techniques adopted to avoid suture line disruption, periprosthetic leakage, patch dislodgement, pericardial patch aneurysm formation, and the long-term stability of aortic root enlargement (ARE) during aortic valve replacement (AVR). Methods One hundred fifteen patients undergoing AVR or combined aortic and mitral valve replacements with Nicks' posterior ARE between 1997 and 2019 underwent long-term echocardiographic and angio-computed tomographic evaluation. Age was 11-72 years (AVR: median, 30; interquartile range, 21-47 years; AVR and mitral valve replacement: median, 27.5; interquartile range, 20-37.5 years). The aortotomy was closed using autologous pericardial patch and Teflon-buttressed sutures. Results Hospital mortality was 1.7% (n = 2), with 4 (3.5%) late deaths. At a mean follow-up of 123.11 ± 77.67 months, the survival probability from Kaplan–Meier was 93.25 ± 0.03%. No cases of severe prosthesis–patient mismatch (PPM) were observed, and only 2 patients had moderate PPM. Median aortic root diameters at the level of sinus of Valsalva and sinotubular junction were 32 (29-35) mm and 33 (30-36) mm, respectively, at discharge, and were 33 (30-36) mm, and 33 (31-37) mm, respectively, at latest follow-up, with no cases of late pericardial patch aneurysm. Conclusions ARE is a safe adjunct to AVR in patients with a small aortic annulus to prevent PPM. Retention of a pericardial collar and Teflon-buttressed sutures is an expedient, safe, and effective technique in reducing bleeding at the enlarged ventriculo-aortic junction. Autologous pericardial patch aortoplasty is not associated with late aneurysm/pseudoaneurysm formation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Figure 1 Graphic display (n = 115) showing pericardial collar and Teflon-buttressed sutures at the ventriculo-aortic junction with no aneurysm/pseudoaneurysm formation.…”

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confidence: 99%

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