Aortic annular enlargement using the Yang technique: the first reported case in the Peruvian Ministry of Health

Prosthesis-patient mismatch (PPM) remains an important limitation in patients with a small aortic annulus undergoing surgical aortic valve replacement. The Yang technique (Y-incision) has recently emerged as an effective alternative for achieving greater aortic annular enlargement while maintaining favorable perioperative outcomes. We report the first case of aortic annular enlargement using the Yang technique performed at our institution in a 56-year-old woman with symptomatic severe aortic stenosis and a small aortic annulus. Intraoperative evaluation revealed a 19-mm aortic annulus. After enlargement via a Y-incision and reconstruction with a bovine pericardial patch, a 23-mm mechanical prosthesis was successfully implanted without perioperative complications. Postoperative echocardiography demonstrated adequate prosthetic function, with a significant reduction in transvalvular gradients. Our initial experience suggests that the Yang technique is a safe, reproducible, and feasible option for centers introducing this procedure into their surgical practice. Although limited to a single case, the favorable outcome has encouraged our team to continue performing this technique in carefully selected patients.