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In the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) era, implanting a larger-sized valve during initial aortic valve replacement is important.For smaller aortic annuli, combining aortic annular and left ventricular outflow tract (LVOT) enlargement is essential.The Y-incision procedure helps achieve the implantation of a two-size larger valve.However, it can lead to size discrepancies between the valve and the LVOT, resulting in a residual pressure gradient, and the risk of coronary obstruction after ViV-TAVR remains as the initial surgical valve is implanted tilted in.To resolve these concerns, we combined the Y-incision and Nicks procedures.
Nakamae et al. (Sat,) studied this question.