Early results of aortic root enlargement using y-incision technique (yang technique) in Hanoi Heart Hospital

Abstract

Background: Aortic root enlargement during aortic valve replacement (AVR) prevented patient-prosthesis mismatch (PPM) in patients with a small aortic annulus. The Y-incision technique, described by Yang B., was a simple and effective method that allowed valve upsizing by 2-3 sizes, reduced operative time, and minimized complications.

Methods: An incision was made from the left-noncoronary sinus junction, extended in a Y-shape below the annulus and above the left atrial roof, exposing the aorto-mitral curtain. The annulus was enlarged using a rectangular patch, with the prosthetic valve partially sutured to the patch. Data from patients were retrospectively analyzed and evaluated clinical characteristics and postoperative outcomes.

Results: 27 patients underwent AVR with Yang’s aortic root enlargement at Hanoi Heart Hospital. Procedures included open single-valve surgery, minimally invasive single-valve surgery, double-valve surgery, and valve re-replacement. Valve upsizing by 2 sizes was achieved in 77.8% of patients, and by 3 sizes in 14.8%. Postoperatively, two patients required reoperation for bleeding, none required permanent pacemaker implantation, and there were no early mortalities. The mean postoperative gradient was low (average 12.6 mmHg, maximum 22.7 mmHg).

Conclusion: Yang technique was simple and effective, achieving at least 2-size valve upsizing, reducing operative time, and minimizing complications by avoiding damage to other cardiac structures. Postoperative transvalvular gradients were low, with no cases of PPM.