“Arc” Modification of the Patch for the Y-Incision Aortic Annular Enlargement

Y-incision aortic annular enlargement has been used for 4 years with favorable early outcomes. Occasionally, we have seen a tensed anastomotic suture line of the rectangular patch to the aortomitral curtain/mitral annulus. We developed an Arc modification of the rectangular patch that completely resolved this issue. The Arc modification has been our new routine since May 2024 for Y-incision aortic annular enlargement in all first-time aortic valve replacements or in some reoperative aortic valve replacements if the aortomitral curtain was preserved. The outcomes were favorable, and there were no issues of hemostasis of the suture line.