{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:18:29Z","timestamp":1787008709050,"version":"build-2736575974"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1093\/ejcts\/ezaf353","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T12:22:39Z","timestamp":1760617359000},"source":"Crossref","is-referenced-by-count":5,"title":["Y-Incision Aortic Annular Enlargement in Patients With Anomalous Left Circumflex Artery"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4769-3129","authenticated-orcid":false,"given":"Kanhua","family":"Yin","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University of Michigan , Ann Arbor, MI 48109,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Titsworth","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University of Michigan , Ann Arbor, MI 48109,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2158-9155","authenticated-orcid":false,"given":"Bo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University of Michigan , Ann Arbor, MI 48109,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"2025111001102576500_ezaf353-B1","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.athoracsur.2025.01.016","article-title":"Aortic annular enlargement: Y-Incision rationale, technique, and outcomes","volume":"119","author":"Chen","year":"2025","journal-title":"Ann Thorac Surg"},{"key":"2025111001102576500_ezaf353-B2","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.atssr.2024.09.008","article-title":"\u201cArc\u201d modification of the patch for the Y-Incision aortic annular enlargement","volume":"3","author":"Yang","year":"2025","journal-title":"Ann Thorac Surg Short Rep"},{"key":"2025111001102576500_ezaf353-B3","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.xjtc.2022.01.006","article-title":"\u201cRoof\u201d technique-a modified aortotomy closure in Y-incision aortic root enlargement upsizing 3-4 valve sizes","volume":"12","author":"Yang","year":"2022","journal-title":"JTCVS Tech"},{"key":"2025111001102576500_ezaf353-B4","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1017\/S1047951124025368","article-title":"Do anomalous aortic origin of a coronary artery patients have higher risk of myocardial ischaemia and adverse cardiac events during aortic and mitral valve replacements","volume":"34","author":"McCloskey","year":"2024","journal-title":"Cardiol Young"},{"key":"2025111001102576500_ezaf353-B5","doi-asserted-by":"crossref","first-page":"3125","DOI":"10.1111\/jocs.14927","article-title":"AVR in patients with anomalous course of the circumflex artery without prosthetic downsizing","volume":"35","author":"Botta","year":"2020","journal-title":"J Card Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf353\/64718594\/ezaf353.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/11\/ezaf353\/64718594\/ezaf353.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/11\/ezaf353\/64718594\/ezaf353.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T06:10:35Z","timestamp":1762755035000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf353\/8287762"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":5,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf353","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,10,16]]},"article-number":"ezaf353"}}