Y-Incision Aortic Annular Enlargement in Patients With Anomalous Left Circumflex Artery

Y-incision aortic annular enlargement (Y-AAE) is increasingly utilized to facilitate valve upsizing. Its application in patients with an anomalous left circumflex artery (LCx) introduces additional complexity. We present a case of a Y-AAE with aortic valve replacement in a patient with an anomalous LCx originating from the right coronary sinus. The annulus was enlarged from 25 mm to accommodate a size 29 prosthesis. The anomalous LCx was carefully dissected from the aortic root and preserved, with no postoperative myocardial ischaemia. We reviewed 4 institutional cases of Y-AAE with upsizing by 3 valve sizes or to the largest size (size 29). One patient required primary repair of an LCx injury. During follow-up of up to 3 years, no patient developed myocardial ischaemia. These findings suggest that Y-AAE can be safely performed in the presence of an anomalous LCx, enabling optimal valve upsizing.