Defining the Efficacy of Aortic Root Enlargement Procedures: A Comparative Analysis of Surgical Techniques

Losenno, Katie L.; Gelinas, Jill; Johnson, Marjorie; Chu, Michael

doi:10.1016/j.cjca.2012.04.012

Cited by 15 publications

(13 citation statements)

References 22 publications

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“…In our practice, the Nicks procedure has been performed in many patients with aortic diameters smaller than 19 mm. However, similar to the findings reported by Peterson 6) and Lesenno, 7) we have noted that these techniques are able to enlarge the annulus by only 2-3 mm. In order to use these techniques in the present case, a prosthetic valve smaller than 18 mm would have been required.…”

Section: Discussionsupporting

confidence: 65%

Use of the Konno Procedure in an 80-year-old Woman with Aortic Stenosis, a Narrow Left Ventricular Outflow Tract, and a Small Aortic Annulus

Misumi¹,

Katayama²,

Takaji³

et al. 2014

ATCS

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This report describes a technique for repairing an aortic stenosis in an elderly patient with a small aortic annulus and a narrow left ventricular outflow tract. Preoperative echocardiography in an 80-year-old woman showed severe aortic stenosis with a narrow outflow tract: the aortic valve area was 0.48 cm 2 , the aortic annular diameter was 14 mm, and the left ventricular outflow tract diameter was 14 mm. The Konno procedure was used to enlarge both the small aortic annulus and the left ventricular outflow tract, and a 19-mm Carpentier-Edwards bioprosthetic valve was implanted. The patient's postoperative course was uneventful. The left ventricular mass decreased from a preoperative value of 236 g to 96 g, 3 years after surgery. Only a few reports have described the use of the Konno operation in adult patients. In the present case, the Konno operation was demonstrated to be a good option for aortic stenosis accompanied by a small aortic annulus and a narrow left ventricular outflow tract, even in an elderly patient.

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Section: Discussionsupporting

confidence: 65%

Use of the Konno Procedure in an 80-year-old Woman with Aortic Stenosis, a Narrow Left Ventricular Outflow Tract, and a Small Aortic Annulus

Misumi¹,

Katayama²,

Takaji³

et al. 2014

ATCS

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“…This finding was not consistent for the Nicks technique. 38 The statistics suggest that the Manouguian procedure may be more effective at reducing PPM than Nicks procedure. This is surprising because the Nicks technique tends to be the most popular among surgeons.…”

Section: Comparative Analysis Of Outcomes Of the Different Surgicalmentioning

confidence: 99%

“…Despite this, the Nicks technique has been shown to provide the lowest degree of annulus enlargement. 38 Therefore, it may not be the best option for when the installation of a much larger prostheses is desired. Clinicians have conducted the Nunez technique in combination with AVR, finding it to be safe.…”

Section: Comparative Analysis Of Outcomes Of the Different Surgicalmentioning

confidence: 99%

Aortic root enlargement: When and how

et al. 2020

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Aortic valve replacement is the definitive management for severe aortic stenosis. Intraoperatively, an aortic root enlargement (ARE) may be used to facilitate the implementation of a suitably sized prosthetic valve. This is to prevent patient prosthesis mismatch (PPM), a condition that causes a left ventricular outflow obstruction. There are four main techniques that are used to perform ARE, namely, Nicks, Manouguian, Nunez (modified Manouguian), and Kanno-Rastan procedures. They each involve incisions through different anatomical structures and allow a variety of valve sizes to be implanted. Studies prove that ARE effectively reduces the incidence of PPM. In addition, they show that there is no definitive link between ARE and perioperative mortality or other complications. There is a scarcity of literature exploring the comparative outcomes of each surgical technique. Therefore, further research is warranted for these procedures to be compared adequately. This review aims to summarise the available literature surrounding ARE with respect to three main questions. (1) What are the indications for ARE, (2) what surgical techniques exist to facilitate ARE, and (3) are there significant differences in patient outcomes when these surgical techniques are employed?

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“…A narrow aortic anulus also has clinical implications for valve replacement surgery, in which placement of a prosthetic valve may be hindered by a base too narrow for proper attachment, requiring aortic root enlargement prior to the valve replacement. The Nicks and Manouguian techniques mentioned above are both aortic root enlargement procedures, as are the modified Bentall and Konno aortoventriculoplasty procedures (Losenno et al, ). Shimizu and Yozu () reported that valve‐sparing root repair has become widely accepted, but that the Bentall procedure remains the most commonly used procedure since it involves replacement of the entire aortic root and valve, and does not require proper alignment of a graft within the root.…”

Section: Clinical Significancementioning

confidence: 99%

The anatomy of the aortic root

Loukas

Bilinsky

et al. 2013

Clinical Anatomy

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The aortic root is the anatomical bridge between the left ventricle and the ascending aorta. It is made up of the aortic valve leaflets, which are supported by the aortic sinuses (of Valsalva), and the interleaflet triangles interposed between the basal attachments of the leaflets. As such, it possesses significant length, and because of the semilunar attachment of the leaflets, there is no discrete proximal border to the root. It is limited distally, nonetheless, by the supravalvar ridge, or sinutubular junction. Descriptions of the aortic root over the years have been bedeviled by accounts of a valve anulus. There are at least two rings within the root, but neither serves to support the valve leaflets, each leaflets being attached in semilunar fashion from the sinutubular junction to a basal ventricular attachment Two leaflets are supported by muscle, and the third has an exclusively fibrous attachment. The root acts as a bridging structure not only anatomically, separating the myocardial and arterial components of the left ventricular pathway, but also functionally, since its proximal and distal components can withstand considerable changes in ventricular and arterial pressures. In this review, we describe the anatomy of this crucial cardiac component, emphasizing the current problems which have arisen due to indiscriminate descriptions of a nonexistent anulus.

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Defining the Efficacy of Aortic Root Enlargement Procedures: A Comparative Analysis of Surgical Techniques

Cited by 15 publications

References 22 publications

Use of the Konno Procedure in an 80-year-old Woman with Aortic Stenosis, a Narrow Left Ventricular Outflow Tract, and a Small Aortic Annulus

Use of the Konno Procedure in an 80-year-old Woman with Aortic Stenosis, a Narrow Left Ventricular Outflow Tract, and a Small Aortic Annulus

Aortic root enlargement: When and how

The anatomy of the aortic root

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