Key result
Bo-Yang aortic root enlargement achieves 0% 30-day mortality and eliminates prosthesis-patient mismatch during SAVR.
Why the study?
Lower body surface area predisposes Indian patients to small aortic annuli and prosthesis-patient mismatch after SAVR, but Indian data on the Bo-Yang Y-incision technique are lacking.
Does the Bo-Yang Y-incision aortic root enlargement technique safely facilitate annular upsizing and prevent predicted prosthesis-patient mismatch in Indian patients with severe aortic stenosis and small annuli undergoing SAVR?
Observational (n=33)
No
Does the Bo-Yang Y-incision aortic root enlargement technique safely facilitate annular upsizing and prevent predicted prosthesis-patient mismatch in Indian patients with severe aortic stenosis and small annuli undergoing SAVR?
The Bo-Yang Y-incision aortic root enlargement technique is feasible and safe in Indian patients with small aortic annuli, effectively allowing for larger prosthesis implantation to prevent patient-prosthesis mismatch.
May reduce PPM after SAVR in Indian patients with small annuli; leaves open need for randomized confirmation.
Objective Lower body surface area predisposes Indian patients to small aortic annuli and prosthesis–patient mismatch (PPM) after surgical aortic valve replacement, increasing late mortality. The Bo–Yang (Y-incision) technique enlarges the posterior aortic root through the aortomitral curtain and fibrous trigones, sparing the anterior mitral leaflet and conduction system, but Indian data are lacking. Methods We prospectively enrolled 33 consecutive adults with severe aortic stenosis and small annuli (≤22 mm) undergoing SAVR with BYARE at a single Mumbai centre (2024–2026). Primary endpoints were 30-day mortality and predicted risk of PPM (predicted iEOA <0.85 cm 2 /m 2 , not measured postoperatively); secondary endpoints were annular upsizing, early extubation, and complications. Results Patients (17 men, 16 women; mean age 53.9 ± 12.9 years; mean BSA 1.77 ± 0.19 m 2 ) were all NYHA class ≥III, with 7 (21.2%) redo sternotomies. Mean annular diameter was 19.7 ± 1.8 mm and prosthesis size 23.8 ± 1.9 mm (upsizing 4.1 mm). Early extubation (<6 hours) occurred in 90.9% of patients, with no 30-day mortality, no paravalvular leak, and no patient predicted to be at risk of clinically significant PPM (mean predicted iEOA 1.01 ± 0.17 cm 2 /m 2 ). Conclusions BYARE is technically feasible and associated with favourable early outcomes in a heterogeneous Indian cohort, facilitating annular upsizing and minimising predicted PPM risk. PPM was estimated, not measured, and longer-term multicentre evaluation is needed to confirm durability.
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Panda et al. (2026) conducted an observational in Severe aortic stenosis and small annuli (n=33). Bo-Yang (Y-incision) aortic root enlargement was evaluated on 30-day mortality and predicted risk of prosthesis-patient mismatch (predicted iEOA <0.85 cm2/m2). Bo-Yang Y-incision aortic root enlargement during surgical aortic valve replacement was feasible, resulting in 0% 30-day mortality and 0% predicted risk of prosthesis-patient mismatch.
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