Chen Sarah A, Do-Nguyen Chi Chi, Titsworth Marc, Yang Bo
Division of Cardiac Surgery, University of California, Davis, Sacramento, California.
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Ann Thorac Surg. 2025 Jun;119(6):1151-1165. doi: 10.1016/j.athoracsur.2025.01.016. Epub 2025 Jan 30.
Trials comparing transcatheter aortic valve replacement and surgical aortic valve replacement (SAVR) have shown that in patients with annuli <26 mm, SAVR had negative hemodynamic and clinical outcomes. Recently, studies revealed that the effective orifice diameter of surgical prosthetic valves is 5-7 mm smaller than the labeled valve size. To improve outcomes of SAVR, the Y-incision aortic annular enlargement (AAE) enlarges the surgical aortic annulus to accommodate a prosthetic valve 3-4 sizes larger with an effective orifice area that matches the patient's native annulus. This review discusses when and how the Y-incision AAE should be performed.
OVID MEDLINE, OVID Embase, and Cochrane Library were searched with terms that included "Y-incision aortic annular enlargement," "valve sizes," and "long-term survival." The search included publications after 2020. The reference lists of included studies were reviewed to retrieve additional studies.
In patients with matched native annular sizes, AAE significantly improved midterm survival without increasing perioperative complications. Patients treated with a larger valve had notably better long-term survival and small valve sizes were significant risk factors for operative and long-term mortality. Compared with patients treated with a Nicks or Manougian procedure, the hemodynamics in patients treated with Y-incision AAE were significantly better.
Y-incision AAE could be routinely considered for patients with a normal annulus (17-25 mm) undergoing SAVR.
比较经导管主动脉瓣置换术和外科主动脉瓣置换术（SAVR）的试验表明，对于瓣环小于26mm的患者，SAVR具有不良的血流动力学和临床结果。最近，研究表明外科人工瓣膜的有效瓣口直径比标记的瓣膜尺寸小5-7mm。为了改善SAVR的结果，Y形切口主动脉瓣环扩大术（AAE）可扩大外科主动脉瓣环，以容纳大3-4个尺寸的人工瓣膜，其有效瓣口面积与患者的天然瓣环相匹配。本综述讨论了何时以及如何进行Y形切口AAE。
使用包括“Y形切口主动脉瓣环扩大术”、“瓣膜尺寸”和“长期生存”等术语检索OVID MEDLINE、OVID Embase和Cochrane图书馆。检索包括2020年后发表的文献。对纳入研究的参考文献列表进行审查以检索其他研究。
在天然瓣环尺寸匹配的患者中，AAE显著改善了中期生存，且未增加围手术期并发症。使用较大瓣膜治疗的患者长期生存明显更好，而小瓣膜尺寸是手术和长期死亡的重要危险因素。与接受Nicks或Manougian手术的患者相比，接受Y形切口AAE治疗的患者血流动力学明显更好。
对于接受SAVR的正常瓣环（17-25mm）患者，可常规考虑Y形切口AAE。
