loading page

Modified Manouguian Technique for Aortic Root Enlargement: A Case Series
  • +1
  • Madison Malfitano,
  • Julia A. Brickey,
  • Aurélie Merlo,
  • Thomas Caranasos
Madison Malfitano
University of North Carolina at Chapel Hill School of Medicine

Corresponding Author:[email protected]

Author Profile
Julia A. Brickey
University of North Carolina at Chapel Hill School of Medicine
Author Profile
Aurélie Merlo
UNC Medical Center
Author Profile
Thomas Caranasos
UNC Medical Center
Author Profile


Background:  Manouguian aortic root enlargement (ARE) has been a standard root enlargement procedure to assist in patients with a small annular size. We describe a modification to the Manouguian ARE similar to Yang et al. This approach could serve as an alternate technique for performing ARE; to date only case reports have defined this approach and no studies have evaluated its efficacy or safety. Methods:  A retrospective case series was performed on patients who underwent ARE for surgical aortic valve replacement via the modified Manouguian procedure at a single institution. Thirteen patients were identified between 2015-2021, and all surgeries were performed by a single operator. Data were collected via the Society of Thoracic Surgeons database and chart review. The primary outcome was difference in valve size after the procedure.  Results:  The most common indication for surgery was aortic stenosis (12, 92%), with the most common etiology being degenerative calcification (7, 54%). Congenital bicuspid or uni-cuspid valves were identified in 5 (38%) patients. The majority (10, 77%) of patients received a mechanical valve. This procedure was successfully performed in all 13 of the patients. Additionally, 13 of the 13 patients (100%) were upsized to a satisfactory valve size based on pre-operative echocardiography sizing. Conclusions:  The modified Manouguian aortic enlargement technique can be safely and effectively used as an aortic enlargement procedure in a broad sample of patients.
26 Oct 2021Submitted to Journal of Cardiac Surgery
26 Oct 2021Submission Checks Completed
26 Oct 2021Assigned to Editor
03 Nov 2021Reviewer(s) Assigned
03 Nov 2021Review(s) Completed, Editorial Evaluation Pending
03 Nov 2021Editorial Decision: Revise Major
16 Nov 20211st Revision Received
16 Nov 2021Submission Checks Completed
16 Nov 2021Assigned to Editor
16 Nov 2021Reviewer(s) Assigned
16 Nov 2021Review(s) Completed, Editorial Evaluation Pending
16 Nov 2021Editorial Decision: Accept
Mar 2022Published in Journal of Cardiac Surgery volume 37 issue 3 on pages 574-578. 10.1111/jocs.16194