Aortic Root Enlargement of a Small Annulus Using the Nicks Technique During Aortic Valve Replacement

Background: In patients with aortic stenosis and small aortic annulus, the surgical approach may lead to implantation of anaortic prosthesis without the necessary hemodynamic profile, conditioning the development of patient-prosthesis mismatch.In these cases, aortic root enlargement becomes a necessary procedure.Objectives: The aim of this study was to describe the incidence of small aortic annulus and the outcomes of aortic root enlargement.Methods: A total of 305 adults undergoing aortic valve replacement were prospectively studied between 2011 and 2013. Aorticroot enlargement was performed in cases of small aortic annulus (< 21 mm) using the Nicks technique.Results: Aortic root enlargement was required in 7.5% of cases. All these patients were women (p < 0.001) with mean age of71.1 years. Height (p < 0.001) and body mass index (p < 0.001) were lower in the group with aortic root enlargement, andthe procedure lasted 10 to 11 minutes more. Mortality associated with aortic root enlargement was 4.3% (1/23) versus 3.5%in patients not undergoing this procedure (RR 1.23, 95% CI 0.16-9.16; p = 0.584).Conclusions: One out of every 14 aortic valve replacements required aortic root enlargement. Female gender and small bodysurface area were associated with the need of enlargement. The Nicks technique can be performed after a short learningcurve, without an excessive increase in risk or operative time.