The Nicks Technique for Aortic Root Enlargement

Aortic root enlargement may be necessary for a small aortic annulus to allow the implantation of a larger aortic valve prosthesis. Larger prostheses are associated with a lower incidence of patient prosthesis mismatch and lower rates of structural valve deterioration. Looking to the future, a larger aortic valve prosthesis will facilitate valve-in-valve aortic replacements by allowing the placement of a larger valve and decreasing the chances of coronary compromise. In this presentation, the authors describe the Nicks procedure, which enlarges the root by extending the aortotomy across the noncoronary sinus through the annulus into the anterior leaflet of the mitral valve.