Early evaluation of the aortic root after Nicks' procedure

Chowdhury, Ujjwal K.; Singh, Sukhjeet; George, Niwin; Hasija, Suruchi; Sankhyan, Lakshmikumari; Pandey, Niraj Nirmal; Sengupta, Sanjoy; Kalaivani, Mani

doi:10.1016/j.xjtc.2020.08.017

Cited by 12 publications

(11 citation statements)

References 33 publications

(167 reference statements)

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“…Similar excellent results have been published in 2020 by Chowdhury et al, from New Delhi, India 11 . concerning a cohort of 115 patients undergoing ARE between 1997 and 2019.…”

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confidence: 87%

Aortic root enlargement: Is it still the best surgical tool to avoid patient‐prosthesis mismatch after aortic valve replacement?

Stefanelli

2022

Journal of Cardiac Surgery

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Avoidance of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR), particularly in younger and active patients, is mandatory to obtain appreciable clinical outcomes. 1,2 The risk of PPM can be predicted by simple and reproducible diagnostic methods useful to evaluate the size of the aortic annulus and the valve area. 3 Even a residual moderate PPM, defined as an indexed effective aortic orifice area <0.85 cm 2 /m 2 has been associated with reduced left ventricular mass regression and increased mortality in patients undergoing AVR. 4 Assessment of transvalvular gradient at rest by transthoracic echocardiography remains the standard diagnostic tool for evaluating patients after AVR, but its reliability is limited by the observation that the gradient increases considerably during physical exercise, 5 and this often happens in the younger population.Several surgical options are available to prevent PPM. In cases where a biological valve is chosen a stentless or a sutureless valve may be a good option in younger patients, 6 while a TAVI seems the ideal approach in the elderly. However, in this perspective, and as the only solution in patients receiving a mechanical valve, aortic root enlargement (ARE), first proposed by Nicks et al., 7 and later modified by Manouguian et al. 8 has shown to be a safe, reproducible and low-risk technique. For these patients, indeed, ARE represents the best technique available to reduce or overcome the risk of severe or moderate PPM, by facilitating the implant of a larger prosthesis. The most frequently used material to How to cite this article: Stefanelli G. Aortic root enlargement:Is it still the best surgical tool to avoid patient-prosthesis mismatch after aortic valve replacement?

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“…Similar excellent results have been published in 2020 by Chowdhury et al, from New Delhi, India 11 . concerning a cohort of 115 patients undergoing ARE between 1997 and 2019.…”

supporting

confidence: 87%

Aortic root enlargement: Is it still the best surgical tool to avoid patient‐prosthesis mismatch after aortic valve replacement?

Stefanelli

2022

Journal of Cardiac Surgery

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“…Patch materials influence the occurrence of restenosis and aortic insufficiency, but the selection of patch materials varied in operators and hospitals ( 16 , 49 – 52 ). Future studies should be adequately designed to apply several clinically validated patch materials for postoperative efficacy analysis.…”

Section: Future Prospectivementioning

confidence: 99%

Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis

Lang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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ImportanceThe safety and efficacy of different surgical repairs of supravalvar aortic stenosis (SVAS) are inconsistent.ObjectiveTo compare the prognosis of single-, two- and three-patch repair for patients with SVAS.Data sourcesPubMed, EMBASE, Cochrane Library, Web of Science, and clinicaltrials.gov were searched until April 17, 2022.Study selectionStudy reported SVAS patients treated with single-, two- or three-patch repair.Data extraction and synthesisTwo reviewers independently extracted the data of study characteristics and clinical outcomes. Multiple pairwise and frequentist network meta-analyses were conducted. And a fixed-effect model was used when no heterogeneity existed.Main outcomes and measuresOutcomes included the rate of reintervention, aortic insufficiency, early mortality and late mortality, cardiopulmonary bypass (CPB) time, cross-clamping (CCP) time, and postoperative/ follow-up pressure gradient. Binary variables were evaluated by odds ratio (OR) and its 95% confidence interval (CI), while continuous variables were assessed by standardized mean difference (SMD) and its 95% CI.ResultsTwenty-seven retrospective cohort studies were included, comprising 1,162 patients, undergoing single-patch (46.6% of cases), two-patch (33.9%), and three-patch repair (19.4%). Two-patch method had a lower rate of reintervention compared with single-patch (OR = 0.47, 95 % CI 0.28–0.89), and three-patch (OR = 0.31, 95 % CI 0.15–0.64). This finding also applied to juvenile and non-Asian patients. Three-patch method had a lower rate of aortic insufficiency compared with single-patch (OR = 0.11, 95 % CI 0.01–0.63), and two-patch (OR = 0.11, 95 % CI 0.02–0.83). But this repair had the longest CCP time, which was significantly longer than that of single- (SMD = 0.76, 95 % CI 0.36–1.17) or two-patch repair (SMD = 0.61, 95 % CI 0.06–1.16). No significant difference was found in mortality and pressure gradient among three procedures.Conclusion and relevanceTwo-patch repair has the lowest reintervention rate and relatively reasonable operation time. Complex and severe SVAS is suggested to be treated with two-patch repair. Further prospective studies of a reasonable sample size will be required with a special focus on the use of different patch materials and surgeons' unique working experience.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022328146.

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“…4 There is an ongoing debate around whether ARE carries additional operative risks, in particular via prolonged bypass and ischemia times, subannular bleeding, paraprosthetic leakage, suture line disruption, patch dislodgement, and aneurysm formation. 5 However, multiple studies have evidenced no increases in surgical risk or adverse events and have highlighted ARE to be a safe addition overall to AVR. 6,7 This article demonstrates a single-center experience using Nick's technique as an adjunct to AVR to reduce the risks of PPM and improve postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

Outcomes Post-Nick's Aortic Root Enlargement Technique: Single-Center Experience

et al. 2022

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Background Different techniques for aortic root enlargement (ARE) have been reported in the literature. Each technique comes with its own advantages and disadvantages. We report our outcomes of Nick's technique for ARE. Methods A single-center retrospective data analysis of 31 patients was performed. Patients were operated between May 2015 and November 2017 at Assuit University Heart Hospital, Assuit, Egypt. Results The median cardiopulmonary bypass time was 125 minutes (range: 90.0–160.0 minutes), with 90 minutes of cross-clamp (range: 60.0–110.0 minutes). Altogether 59% of the patients had mixed aortic valve diseases. Median intensive care unit and total hospital stay were 2 and 5 days, respectively. Patient-prosthesis mismatch was reported in one patient only (3.25%). Two patients died within 30 days. Median pressure gradient across the aortic valve was 20 mm Hg at 3 years of follow-up. Conclusion The benefits of Nick's technique for ARE can be demonstrated in populations with younger patients and complicated pathology. Further research is required in larger patient populations.

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Early evaluation of the aortic root after Nicks' procedure

Cited by 12 publications

References 33 publications

Aortic root enlargement: Is it still the best surgical tool to avoid patient‐prosthesis mismatch after aortic valve replacement?

Aortic root enlargement: Is it still the best surgical tool to avoid patient‐prosthesis mismatch after aortic valve replacement?

Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis

Outcomes Post-Nick's Aortic Root Enlargement Technique: Single-Center Experience

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