Bo-yang Y-incision aortic root enlargement in Indian patients undergoing surgical aortic valve replacement: A...

Lower body surface area predisposes Indian patients to small aortic annuli and prosthesis-patient mismatch (PPM) after surgical aortic valve replacement, increasing late mortality. The Bo-Yang (Y-incision) technique enlarges the posterior aortic root through the aortomitral curtain and fibrous trigones, sparing the anterior mitral leaflet and conduction system, but Indian data are lacking.

We prospectively enrolled 33 consecutive adults with severe aortic stenosis and small annuli (≤22 mm) undergoing SAVR with BYARE at a single Mumbai centre (2024-2026). Primary endpoints were 30-day mortality and predicted risk of PPM (predicted iEOA <0.85 cm²/m², not measured postoperatively); secondary endpoints were annular upsizing, early extubation, and complications.

Patients (17 men, 16 women; mean age 53.9 ± 12.9 years; mean BSA 1.77 ± 0.19 m²) were all NYHA class ≥ III, with 7 (21.2%) redo sternotomies. Mean annular diameter was 19.7 ± 1.8 mm and prosthesis size 23.8 ± 1.9 mm (upsizing 4.1 mm). Early extubation (<6 h) occurred in 90.9% of patients, with no 30-day mortality, no paravalvular leak, and no patient predicted to be at risk of clinically significant PPM (mean predicted iEOA 1.01 ± 0.17 cm²/m²).

BYARE is technically feasible and associated with favourable early outcomes in a heterogeneous Indian cohort, facilitating annular upsizing and minimising predicted PPM risk. PPM was estimated, not measured, and longer-term multicentre evaluation is needed to confirm durability.