The Konno Procedure in Redo Aortic Valve Replacement after the Nicks Procedure.

A case is reported of successful surgery using the Konno procedure seven years after the patient had undergone aortic valve replacement (AVR) with the Nicks procedure. A 79-year-old woman with aortic stenosis and a small aortic annulus had undergone previous AVR with a 17-mm mechanical prosthesis and aortic annular enlargement by the Nicks procedure. Redo surgery was performed using a 19-mm bioprosthesis with the Konno procedure, to replace a valve that had become stuck due to pannus formation. As intense adhesion was present around the heart, especially behind the posterior aortic wall where the Nicks procedure had been performed, the Konno procedure provided the advantage of a good field of vision at the aortic annulus. This procedure may be less invasive when applied to adults, because the septal incision in adults would be relatively smaller than in children. As well as being used in children, the Konno procedure could be an effective option for redo AVR in adults with a small aortic annulus.