Nicks Procedure

Surgical aortic valve replacement (AVR) is a routinely performed procedure for the treatment of patients suffering from severe aortic stenosis. Despite its excellent results, patient prosthesis mismatch (PPM) may ensue when a small-sized valve is implanted in a small aortic root. The increased pressure gradient across the valve with decreased exercise tolerance and delayed regression of left ventricular hypertrophy are among the complications encountered. Various procedures have been described in the literature to enlarge the aortic root to be able to implant a bigger valve thus avoiding PPM. There are many options for small aortic root, involving posterior aortic root enlargement (ARE) including Nicks, Manougian, Konno-Rastan (anterior enlargement), and sutureless valves. One of the easily performed techniques is the Nicks procedure. The Nicks procedure for aortic root enlargement avoids PPM, allows for a valve in valve placement in the future, and helps to prevent structural valve deterioration.