Abstract:
Objective: To analyze the superiority, feasibility and problems of Nicks and Manougian procedures 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 September 2017 conducted at Health Sciences University Haydarpasa Numune Hospital. The study included patients who underwent Manougian and Nicks procedures between 2009-2017. The effects of the procedures on left ventricular functions at the postoperative 0-12th months, postoperative complications and mortality were evaluated. Cases with (I) isolated aortic stenosis without additional valve pathology who undergone ARE, with (II) BSA index between 1,40-1,70 m2, and cases undergone (III) standard mechanical aortic valve (Carbomedics) replacement with Manougian and Nicks methods were included. Echocardiographical data of the cases were 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 effective orifice area index was higher in the Manougian procedure (1,28Vs1,17cm/ 2 m ;p=0,001). NYHA functional capacity was decreased by 1.58±0.7 postoperatively (inter-procedures p=0,809). Early and late mortality rates for Manougian and Nicks procedures were 0% , 2,2% and 2,5%, 2,2%, respectively (p=0,641). Reoperation rate due to bleeding, thrombosis, infection and the paravalvular leak was 15% at the end of the first year (inter-procedures p=0,565).The changes of echocardiographic parameters were significant in all cases against time. On the other hand, fractional shortening and gradient changes were significantly higher for Manougian procedure compared to Nicks, while ejection fraction and septum thickness change were not significant. Conclusion: Although both methods had a positive effect on left ventricular function, Manougian procedure was more effective because it provided a larger valve area and near-normal left ventricular function. Considering risk factors for the optimal size valve implant, the choice of root dilatation method instead of alternative prostheses doesn't affect morbidity and mortality.
Page(s):
338-348
DOI:
DOI not available
Published:
Journal: Pakistan Heart Journal, Volume: 52, Issue: 4, Year: 2019
Keywords:
Effective orifice area index
,
Manougian procedure
,
Nicks procedure
,
Aortic root enlargement
,
Patientprosthesis mismatch
,
Septum thickness