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Changes in aortic root dimensions post aortic root enlargement with Y-incision and modified aortotomy
William Truesdell1, Corina Ghita2, China Green2
1Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
Annals of Cardiothoracic Surgery
|June 6, 2024
Summary
Aortic root enlargement using the Y-incision technique significantly increases aortic root and sinotubular junction diameters. This facilitates future valve-in-valve procedures by improving anatomy for aortic stenosis management.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Interventional Cardiology
Background:
- Aortic stenosis (AS) management requires strategies for future valve interventions.
- Aortic root enlargement (ARE) can optimize anatomy for valve-in-valve (ViV) procedures.
- Quantitative analysis of anatomical changes after ARE is needed.
Purpose of the Study:
- To quantitatively analyze changes in aortic root dimensions after a mitral valve-sparing ARE technique.
- To assess the impact of ARE on the annulus, sinuses of Valsalva, and sinotubular junction.
- To evaluate the suitability of the resulting anatomy for future transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV) procedures.
Main Methods:
- Analysis of pre- and post-operative computed tomography angiography (CTA) scans from 45 patients.
- Detailed measurements of the basal ring, sinuses of Valsalva, and sinotubular junction.
- Assessment of changes in coronary artery heights and valve-to-coronary artery distances.
Main Results:
- ARE significantly increased basal ring diameter (26.3 vs. 25.3 mm) and sinus diameters (+6.6–7.7 mm).
- Sinotubular junction diameter increased substantially (to 38.3 mm, +8.1 mm).
- Valve-to-coronary artery distances were preserved post-operatively (LM: 6.6 mm, RCA: 4.9 mm).
Conclusions:
- The Y-incision ARE technique effectively enlarges the aortic root and STJ.
- This technique creates favorable anatomy for future TAV-in-SAV procedures.
- ARE facilitates valve upsizing while maintaining safe coronary artery distances.
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