The new Y-incision annulus enlargement technique, a couse of a Mitral rgurgutaion?

Introduction:

Patient prosthetic mismatch (PPM) is a common issue in aortic valve replacement (AVR), associated with poor hemodynamic outcomes, increased cardiac events, and diminished survival. The Y-incision annulus enlargement technique aims to address this by suturing a rectangular patch to the aorto-mitral curtain, increasing the annulus size by 3-4 sizes. This modification may alter the geometry of the aorto-mitral curtain and anterior mitral valve leaflet, potentially leading to mitral valve insufficiency (MR).

Methods:

This retrospective study was conducted from June 2022 to September 2024, including patients with severe aortic stenosis who were candidates for surgical AVR. Two groups were compared: the first comprised 36 patients who underwent surgical AVR without annular enlargement, while the second included 36 patients who required annular enlargement due to a small aortic annulus, which can lead to significant PPM as indicated by an effective orifice area index (EOAi) of <0.85. All annular enlargements utilized the Y-incision technique. The primary endpoint was the development of new mitral regurgitation (MR) postoperatively or increased MR severity compared to preoperative levels.

Results:

In the non-enlargement group, 27 patients showed no change in MR severity, while 8 experienced improvement of at least one grade. In the Y-incision group, 17 patients had stable MR, and 13 improved by at least one grade. Notably, one patient in the non-enlargement group and 6 in the Y-incision group experienced worsening MR (p = 0.04).

Conclusion:

Our findings suggest that patients with severe aortic stenosis and a small annulus who undergo the Y-incision annular enlargement technique may experience increased mitral regurgitation (MR). However, further research involving larger cohorts and a deeper understanding of the underlying mechanisms is necessary to validate these observations.