Key result
Y-incision aortic annular enlargement enables larger bioprosthetic valve implantation with an 8 mmHg mean gradient.
Why the study?
Aortic annular enlargement reduces prosthesis-patient mismatch and improves postoperative haemodynamics during aortic valve replacement in patients with a small aortic annulus and restricted aortic root anatomy.
Case Report (n=1)
The Y-incision aortic annular enlargement with an arc patch modification successfully facilitated the implantation of a larger bioprosthetic valve, yielding excellent early hemodynamic results.
May facilitate annular enlargement to reduce mismatch in small roots; extends technique descriptions but leaves open need for larger validation.
Aortic annular enlargement is an important adjunct to aortic valve replacement in patients with a small aortic annulus and restricted aortic root anatomy. The Y-incision technique facilitates implantation of a larger prosthetic valve, reducing the risk of prosthesis-patient mismatch and improving postoperative haemodynamics. This video tutorial demonstrates Y-incision aortic annular enlargement combined with bioprosthetic aortic valve replacement in a 67-year-old woman with symptomatic severe aortic stenosis and a severely restricted aortic root anatomy. Preoperative imaging revealed a 19 mm aortic annulus, small aortic root dimensions and a narrow sinotubular junction. Following extensive aortic root mobilization, a Y-shaped incision was extended through the aortomitral curtain and reconstructed using an arc-shaped patch modification to facilitate annular, root and sinotubular junction enlargement. The enlarged annulus allowed implantation of a 23 mm bioprosthetic valve with careful commissural alignment and root reconstruction. Postoperative imaging demonstrated excellent valve position and function without paravalvular leak. Peak and mean transvalvular gradients were 14 and 8 mmHg at discharge, and remained stable at 4-month follow-up. This video tutorial highlights the key technical steps of Y-incision aortic annular enlargement and demonstrates excellent early haemodynamic results following implantation of an appropriately sized prosthesis.
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Rzhanyi et al. (2026) conducted a case report in Symptomatic severe aortic stenosis and severely restricted aortic root anatomy (n=1). Y-incision aortic annular enlargement combined with bioprosthetic aortic valve replacement was evaluated on Postoperative haemodynamics and valve function. Y-incision aortic annular enlargement allowed implantation of a 23 mm bioprosthetic valve with excellent early haemodynamics, including a mean transvalvular gradient of 8 mmHg at 4-month follow-up.
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