The Combined Konno-Nicks Procedure for Severely Stenotic Aortic Root and Left Ventricular Outflow Tract

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe left ventricular outflow tract obstruction and prosthetic valve dysfunction (n=1). Intervention: Combined Konno-Nicks procedure. Primary outcome: Enlargement of the annulus and left ventricular outflow tract with relief of obstruction.

Masafumi Matsuda; Shin Yajima; Daisuke Yoshioka; Kazuo Shimamura; Ai Kawamura; Takuji Kawamura; Yusuke Misumi; Shunsuke Saito; Shigeru Miyagawa

doi:10.1016/j.jaccas.2025.106544

January 1, 2026JACC Case ReportsOpen Access

The Combined Konno-Nicks Procedure for Severely Stenotic Aortic Root and Left Ventricular Outflow Tract

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Key result

Combined Konno-Nicks procedure successfully enlarges small aortic annulus and relieves LVOT obstruction.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY

Why the study?

Patients with a small aortic root and subvalvular stenosis are at risk of prosthesis-patient mismatch, necessitating annular and LVOT enlargement.

Key Points

Implantation of a 4-size larger prosthesis relieved severe subvalvular stenosis, and redo aortic valve replacement eliminated residual outflow tract obstruction.
Surgical intervention using the combined Konno-Nicks procedure widened the small aortic root, allowing effective patch enlargement across the interventricular septum.
Highlights how combined anterior-posterior enlargement prevents prosthesis-patient mismatch, effectively relieving recurrent left ventricular outflow tract obstruction.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 41-year-old woman with prosthetic valve dysfunction, a small aortic root, and severe left ventricular outflow tract obstruction, followed for 1 year post-surgery.

I

Intervention

Redo aortic valve replacement with the combined Konno-Nicks procedure for root and LVOT enlargement, using a 20-mm mechanical prosthesis (ATS AP360) and prophylactic coronary artery bypass grafting (CABG) to the right coronary artery.

O

Outcome

Procedural success, relief of left ventricular outflow tract obstruction, and preservation of valve function as assessed by postoperative echocardiography and computed tomography at 1 year.

Limitations

Potential disadvantages of the procedure include the risk of complete atrioventricular block and residual ventricular septal defects.
Substantial risk of right coronary ostial injury during the Konno incision due to narrow margins.
Scarce literature and lack of long-term outcome data regarding the combined Konno-Nicks procedure

Implication

The combined Konno-Nicks procedure is a clinically feasible surgical approach for redo aortic valve replacement in patients with a severely stenotic aortic root, preventing prosthesis-patient mismatch by allowing adequately sized valve implantation.

Abstract

BACKGROUND: Patients with a small aortic root and subvalvular stenosis are at risk of prosthesis-patient mismatch, making annular and left ventricular outflow tract (LVOT) enlargement essential. CASE SUMMARY: We herein report the case of a 41-year-old woman with prosthetic valve dysfunction and severe LVOT obstruction due to pannus formation in whom a 12-mm sizer could not be passed. Redo aortic valve replacement with the combined Konno-Nicks procedure successfully enlarged the annulus and LVOT, enabling the implantation of a 4-size larger prosthesis based on intraoperative sizer measurements. Postoperative echocardiography and computed tomography confirmed effective valve enlargement and preserved valve function. DISCUSSION: Combined anterior-posterior enlargement can be valuable for redo aortic valve replacement in patients with a small annulus and subvalvular stenosis to prevent prosthesis-patient mismatch. TAKE-HOME MESSAGE: The combined Konno-Nicks procedure can effectively relieve prosthetic valve dysfunction with severe subvalvular stenosis by enabling larger prosthesis implantation.

Discussion

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Cite This Study

Matsuda et al. (2026) conducted a case report in Severe left ventricular outflow tract obstruction and prosthetic valve dysfunction (n=1). Combined Konno-Nicks procedure was evaluated on Enlargement of the annulus and left ventricular outflow tract with relief of obstruction. The combined Konno-Nicks procedure successfully enlarged the annulus and left ventricular outflow tract, enabling implantation of a larger prosthesis and relieving obstruction in a 41-year-old woman.

synapsesocial.com/papers/69a75d27c6e9836116a26b2d https://doi.org/10.1016/j.jaccas.2025.106544

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The Combined Konno-Nicks Procedure for Severely Stenotic Aortic Root and Left Ventricular Outflow Tract

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

The Combined Konno-Nicks Procedure for Severely Stenotic Aortic Root and Left Ventricular Outflow Tract

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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