Surgical Aortic Valve Replacement With Y-incision Aortic Annular Enlargement Provided Better Hemodynamics Than Transcatheter Aortic Valve Replacement

This comparative study evaluated outcomes between surgical aortic valve replacement with Y-incision aortic annular enlargement (SAVR with Y-AAE) vs transcatheter aortic valve replacement (TAVR) in 362 low-to-intermediate risk patients with severe native aortic stenosis and small aortic annuli (≤25mm). The Y-AAE technique allowed upsizing by three to four valve sizes (median size 29) compared to standard TAVR sizing. SAVR with Y-AAE demonstrated significantly superior hemodynamics outcomes at 24 to 36 months, including a larger effective orifice area (2.7 vs 1.9 cm²), lower mean gradients (5 vs 9.5 mmHg), no prosthesis-patient mismatch (0 percent vs 20.1 percent), minimal aortic insufficiency (3.0 percent vs 26 percent), and greater left ventricular mass regression (42 percent vs 22 percent). Operative mortality rates were similar (0 percent vs 2 percent), while pacemaker requirements were lower (1.4 percent vs 10.3 percent). Three-year survival favored SAVR with Y-AAE (98 percent vs 79 percent, p<0.01). The authors conclude that SAVR with Y-incision annular enlargement should be considered for low-to-intermediate risk aortic stenosis patients given its excellent hemodynamics and potential for improved valve longevity.