Aortic root enlargement before and after adaptation of roof technique and arch modification

Background- A very small root and annulus is a challenge for aortic valve replacement, that needs extensive aortic annular enlargement. Previously with the “Y” incision aortic root enlargement technique of Bo-Yang we could enlarge the aortic annulus by 1-2 valve size safely. After adoption of newer modification of with the “roof” technique and arch modification we now can enlarge the aortic root to upsize 3-5 valve sizes.

Methods and materials – We have operated on 15 patients from January 2023 to July 2025 by Y incision Bo Yang technique. Among them in first 6 patients aortic root enlargement was done by Y incision / rectangular patch Bo- Yang technique and we implant 21mm prosthetic valve in 19mm or 18mm aortic root. In remaining 15 patients we adopted the Y incision Bo Yang with roof technique and arch modification and implant 25mm prosthetic valve in 19mm aortic root. All the peri-operative data were collected and stored for statistical analysis.

Conclusion – In our experience aortic annular enlargement by “Y” incision with newer modifications improved survivals without increasing perioperative complications. Patients treated with a larger valve had notably reduced morbidity, increased the quality of life and better long-term survivals.