{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T14:16:48Z","timestamp":1788963408469,"version":"build-2803163510"},"reference-count":0,"publisher":"European Association of Cardiothoracic Surgery (EACTS Publishing Ltd)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MMCTS"],"published-print":{"date-parts":[[2026,9,9]]},"abstract":"<jats:p>Aortic annular enlargement is an important adjunct to aortic valve replacement in patients with a small aortic annulus and restricted aortic root anatomy. The Y-incision technique facilitates implantation of a larger prosthetic valve, reducing the risk of prosthesis\u2013patient mismatch and improving postoperative haemodynamics. This video tutorial demonstrates Y-incision aortic annular enlargement combined with bioprosthetic aortic valve replacement in a 67-year-old woman with symptomatic severe aortic stenosis and a severely restricted aortic root anatomy. Preoperative imaging revealed a 19 mm aortic annulus, small aortic root dimensions and a narrow sinotubular junction. Following extensive aortic root mobilization, a Y-shaped incision was extended through the aortomitral curtain and reconstructed using an arc-shaped patch modification to facilitate annular, root and sinotubular junction enlargement. The enlarged annulus allowed implantation of a 23 mm bioprosthetic valve with careful commissural alignment and root reconstruction. Postoperative imaging demonstrated excellent valve position and function without paravalvular leak. Peak and mean transvalvular gradients were 14 and 8 mmHg at discharge, and remained stable at 4-month follow-up. This video tutorial highlights the key technical steps of Y-incision aortic annular enlargement and demonstrates excellent early haemodynamic results following implantation of an appropriately sized prosthesis.<\/jats:p>","DOI":"10.1510\/mmcts.2026.076","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:57:46Z","timestamp":1788962266000},"source":"Crossref","is-referenced-by-count":0,"title":["Y-incision aortic annular enlargement using the arc patch modification: a step-by-step tutorial"],"prefix":"10.1510","member":"10966","published-online":{"date-parts":[[2026,9,9]]},"container-title":["Multimedia Manual of Cardio-Thoracic Surgery"],"original-title":[],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:57:46Z","timestamp":1788962266000},"score":1,"resource":{"primary":{"URL":"https:\/\/mmcts.org\/tutorial\/2233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1510\/mmcts.2026.076","relation":{},"ISSN":["1813-9175"],"issn-type":[{"value":"1813-9175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}