Mohamed Mostafa M., Bishop Michael A.
Assiut University, Egypt / Manchester Royal Infirmary , Manchester University Foundation Trust , UK
Advent Health Orlando
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.
外科主动脉瓣置换术（AVR）是治疗重度主动脉瓣狭窄患者的常规手术。尽管其效果良好，但当在小主动脉根部植入小尺寸瓣膜时，可能会出现患者-人工瓣膜不匹配（PPM）。瓣膜上压力梯度增加、运动耐量降低以及左心室肥厚消退延迟是所遇到的并发症。文献中描述了各种扩大主动脉根部以便能够植入更大瓣膜从而避免PPM的手术方法。对于小主动脉根部有多种选择，包括后主动脉根部扩大术（ARE），如尼克斯（Nicks）法、马努吉安（Manougian）法、康诺-拉斯坦（Konno-Rastan）法（前扩大术）以及无缝合瓣膜。其中一种易于实施的技术是尼克斯手术。主动脉根部扩大的尼克斯手术可避免PPM，为未来瓣膜内瓣膜植入提供可能，并有助于防止人工瓣膜结构恶化。
