Aortic annular enlargement using the Y-incision technique—How I do it

The Y-incision aortic annular enlargement technique offers a reliable solution for the aortic valve replacement in patients with small aortic annuli. By enlarging the annulus and root using a Y-incision and rectangular patch, this technique enables implantation of significantly larger prostheses to effectively avoid prosthesis-patient mismatch without affecting mitral geometry. Based on our experience using minimally invasive access, tailored patch design, modified closure of aortotomy, and integration with ascending aortic replacement when needed, the technique is reproducible and adaptable. Early outcomes are promising, though long-term follow-up and multicenter comparison are required to evaluate its benefits and potential risks.