Modeling the Hemodynamic Impact of Y-incision Aortic Annular Enlargements on Aortic Valve Replacement and Valve-in-Valve Procedures

Y-incision aortic annular enlargement (Y-AAE) with surgical aortic valve replacement (SAVR) may improve outflow tract hemodynamics and valve-in-valve (ViV) outcomes but could increase thrombosis risk. We used computational fluid dynamics to analyze post-operative hemodynamics in 15 patient-specific SAVR models, comparing cases with and without Y-AAE. ViV scenarios were simulated by virtually deploying transcatheter aortic valves. Transvalvular peak velocities, pressure gradients, and blood residence time (a proxy for hemostatic risk) were analyzed to assess performance across cases. Y-AAE reduced peak velocity by 39.3% (55% in ViV), transvalvular pressure gradient by 87.2% (92% in ViV), and mean blood residence time by 10.3% (14% in ViV), with no consistent difference in maximum residence time. SAVR with Y-AAE demonstrated improved hemodynamics, even with ViV procedures, and no evidence of increased thrombosis risk.