Surgeons at the Medical University of Vienna have developed a method to enlarge the aortic root, allowing for the implantation of significantly larger prosthetic heart valves.

Researchers at the Medical University of Vienna and University Hospital Vienna have introduced a new surgical technique to address the limitations of small aortic roots during valve replacement. The method, known as the Alfred Kocher technique, allows for the implantation of prosthetic valves at least two sizes larger than those typically possible. This approach aims to reduce patient-prosthesis mismatch and improve long-term treatment outcomes for cardiac patients.

Addressing Patient-Prosthesis Mismatch

When replacing a diseased aortic valve, the size of the patient's natural aortic annulus can restrict the size of the prosthetic valve that can be implanted. If the prosthesis is too small relative to the patient's body, the heart must work against increased resistance, a condition known as patient-prosthesis mismatch that is linked to poorer clinical outcomes. The new technique allows surgeons to dilate the aortic root in a relatively simple, minimally invasive manner, ensuring better blood flow.

The Alfred Kocher Technique

The procedure begins like a conventional aortic valve replacement. Once the aortic annulus is measured, surgeons determine if enlargement is necessary. The technique involves a T-shaped incision to the aortic root, which is then reconstructed using a specially shaped patch. This method preserves the natural shape of the aortic root and leaves the coronary arteries unaffected. The technique can be performed via conventional, minimally invasive, or endoscopic access.

Focus on Lifetime Management

Modern cardiac surgery emphasizes 'lifetime management,' where the initial valve replacement considers future interventions, such as transcatheter aortic valve implantation (TAVI). By implanting a larger valve initially, surgeons create better conditions for potential future procedures. The Department of Cardiac and Thoracic Aortic Surgery, led by Daniel Zimpfer, has standardized this approach, which is now being applied at medical centers across Europe and the United States.