Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Book

Nicks Procedure

Mostafa M. Mohamed  1 , Michael A. Bishop  2
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
.
Affiliations
Book

Nicks Procedure

Mostafa M. Mohamed et al.

Excerpt

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.

PubMed Disclaimer

Conflict of interest statement

Disclosure: Mostafa Mohamed declares no relevant financial relationships with ineligible companies.

Disclosure: Michael Bishop declares no relevant financial relationships with ineligible companies.

References

    1. Sá MPBO, Carvalho MMB, Sobral Filho DC, Cavalcanti LRP, Diniz RGS, Rayol SC, Soares AMMN, Sá FBCA, Menezes AM, Clavel MA, Pibarot P, Lima RC. Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients. Interact Cardiovasc Thorac Surg. 2019 Jul 01;29(1):74-82. - PubMed
    1. Subhani H, Hossien A, Tran V, Cook A, Abid Q, Saad R. Anatomic Correlation of Posterior Aortic Root Enlarging Incisions. World J Pediatr Congenit Heart Surg. 2016 Nov;7(6):706-710. - PubMed
    1. Rocha RV, Manlhiot C, Feindel CM, Yau TM, Mueller B, David TE, Ouzounian M. Surgical Enlargement of the Aortic Root Does Not Increase the Operative Risk of Aortic Valve Replacement. Circulation. 2018 Apr 10;137(15):1585-1594. - PubMed
    1. Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax. 1970 May;25(3):339-46. - PMC - PubMed
    1. Srivastava DK, Sanki P, Bhattacharya S, Siddique JV. Strategy to avoid patient-prosthesis mismatch: aortic root enlargement. Asian Cardiovasc Thorac Ann. 2014 Feb;22(2):137-41. - PubMed

Publication types