Key result
Alfred Kocher posterior root enlargement upsizes aortic annulus by ~5 mm, enabling mechanical valve implantation.
Why the study?
In paediatric aortic valve replacement when the Ross procedure is not feasible and the aortic annulus is too small for an adult-sized mechanical prosthesis, patient-prosthesis mismatch arises, and the standardized Konno procedure carries substantial procedural complexity and risk.
Does posterior aortic root enlargement using the Alfred Kocher technique allow annular upsizing to prevent patient-prosthesis mismatch in a pediatric patient ineligible for the Ross procedure?
Case Report (n=1)
Does posterior aortic root enlargement using the Alfred Kocher technique allow annular upsizing to prevent patient-prosthesis mismatch in a pediatric patient ineligible for the Ross procedure?
The Alfred Kocher posterior aortic root enlargement technique allowed a 5 mm annular upsizing to accommodate a 21 mm mechanical aortic valve in a 7-year-old patient ineligible for the Ross procedure.
Answers are grounded in this paper and cite their sources.
May support feasibility of Alfred Kocher enlargement to avoid mismatch in select pediatric AVR; leaves open need for larger series on safety.
Aortic valve replacement requires special considerations in paediatric patients, who are not yet fully grown. The Ross procedure remains the gold standard in paediatric patients as it offers growth potential. If the Ross procedure is not feasible, or the size of the aortic annulus precludes placement of an adult-sized mechanical prosthesis, the problem of patient-prosthesis mismatch and subsequent aortic valve reinterventions arises. The standardized option for this patient cohort is the Konno incision and patch ventriculoplasty in combination with an adult-sized mechanical prosthesis, which carries substantial procedural complexity and risk. This video tutorial demonstrates posterior aortic root enlargement using the Alfred Kocher technique in a 7-year-old female with a functionally unicuspid aortic valve and a bicuspid pulmonary valve. The bicuspid pulmonary valve was an unplanned intraoperative finding, making the patient ineligible for a durable autograft transplantation. The technique involves an inverted T-shaped incision in the centre of the non-coronary sinus, and reconstruction with a barrel-shaped patch tailored from a 28 mm Valsalva prosthesis to augment the non-coronary sinus in an anatomical fashion, allowing upsizing by 5 mm in annular diameter. This technique enabled implantation of a 21 mm size mechanical prosthesis (diameter = 24 mm) upsized from a 19 mm annulus.
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Muríň et al. (2026) conducted a case report in Functionally unicuspid aortic valve and bicuspid pulmonary valve (n=1). Posterior aortic root enlargement using the Alfred Kocher technique was evaluated on Aortic annular diameter upsizing and mechanical prosthesis implantation. Posterior aortic root enlargement using the Alfred Kocher technique upsized the aortic annulus by 5 mm (from 19 mm to 24 mm), enabling implantation of a 21 mm mechanical prosthesis.
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