WHICH METHOD SHOULD BE PREFERRED IN NARROW AORTIC ROOTS? RISKS AND PROGNOSES OF MANOUGUIAN AND NICKS PROCEDURES

Abstract

Objective: To analyze the superiority, feasibility and problems of Nicks and Manougianprocedures in the light of literature data, independent of valve type and BSA values.

Methodology: The study was a cross-sectional study from June 2009 and September2017 conducted at Health Sciences University Haydarpaşa Numune Hospital. Thestudy included patients who underwent Manougian and Nicks procedures between2009-2017. The effects of the procedures on left ventricular functions at thepostoperative 0-12th months, postoperative complications and mortality wereevaluated. Cases with (I) isolated aortic stenosis without additional valve pathologywho undergone ARE, with (II) BSA index between 1,40-1,70 m , and cases undergone 2(III) standard mechanical aortic valve (Carbomedics) replacement with Manougian andNicksmethodswere included. Echocardiographical data of the caseswere evaluated.

Results: The study included 104 patients who underwent Manougian (n=40;46,5%)and Nicks(n=46;53,5%) procedures between 2009-2017. Postoperative effectiveorifice area index was higher in the Manougian procedure (1,28Vs1,17cm/m ;p=0,001). NYHA functional capacity was decreased by 1.58±0.7 postoperatively 2(inter-procedures p=0,809). Early and late mortality rates for Manougian and Nicksprocedures were 0% , 2,2% and 2,5%, 2,2%, respectively (p=0,641). Reoperation ratedue to bleeding, thrombosis, infection and the paravalvular leak was 15% at the end ofthe first year (inter-procedures p=0,565).The changes of echocardiographicparameters were significant in all cases against time. On the other hand, fractionalshortening and gradient changes were significantly higher for Manougian procedurecompared to Nicks, while ejection fraction and septum thickness change were notsignificant.

Conclusion: Although both methods had a positive effect on left ventricular function,Manougian procedure was more effective because it provided a larger valve area andnear-normal left ventricular function. Considering risk factors for the optimal size valveimplant, the choice of root dilatation method instead of alternative prostheses doesn'taffect morbidity and mortality.

Key Words: Effective orifice area index, Manougian procedure, Nicks procedure, Aorticroot enlargement, Patient-prosthesis mismatch, Septum thickness