Managing the small aortic annulus in the era of increasing transcatheter aortic valve replacement explant surgery

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Failed transcatheter aortic valves with small aortic annuli. Intervention: Surgical aortic valve replacement with aortic annular enlargement (e.g., Y-incision technique).

Davut Çekmecelioğlu; Zeynep Bengi Eren; Patrick R. Vargo

doi:10.21037/jovs-2026-0038

September 1, 2026Journal of Visualized SurgeryOpen Access

Managing the small aortic annulus in the era of increasing transcatheter aortic valve replacement explant surgery

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Structured PICO

P

Population

Patients with a small aortic annulus requiring transcatheter aortic valve replacement (TAVR) explantation and surgical aortic valve replacement (SAVR).

I

Intervention

Surgical aortic valve replacement (SAVR) with aortic annular enlargement (AAE), such as the Y-incision technique or double-patch extension, and potentially concomitant septal myectomy.

Limitations

The Y-incision technique requires high surgical expertise and can be technically demanding with longer operative times.
Supravalvular enlargement does not extend into the LVOT, which may predispose to prosthetic valve tilting and unfavorable geometry.
Annular enlargement alone may be insufficient if there is concomitant subvalvular obstruction such as septal hypertrophy.

Implication

When managing patients with small aortic annuli undergoing TAVR explantation, surgeons should evaluate the entire LVOT complex and consider concomitant septal myectomy along with annular enlargement to optimize hemodynamics.

Abstract

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Discussion

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Cite This Study

Çekmecelioğlu et al. (2026) conducted an editorial in Failed transcatheter aortic valves with small aortic annuli. Surgical aortic valve replacement with aortic annular enlargement (e.g., Y-incision technique) was evaluated.

synapsesocial.com/papers/6ad1159100741cc3fba7d60f https://doi.org/10.21037/jovs-2026-0038

View Full Paper

Ask AI

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Managing the small aortic annulus in the era of increasing transcatheter aortic valve replacement explant surgery

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Managing the small aortic annulus in the era of increasing transcatheter aortic valve replacement explant surgery

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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