Quantitative computed tomographic assessment of aortic root geometry after Y-incision aortic root enlargement in patients with small aortic annuli.

Abstract

Objectives: Y-incision aortic root enlargement enables implantation of larger surgical prostheses in patients with small aortic annuli. However, postoperative computed tomography angiography-based data on aortic root geometry, prosthetic valve orientation, and coronary clearance in small-bodied patients remain limited.

Methods: We retrospectively studied 13 consecutive patients who underwent Y-incision aortic root enlargement between May 2023 and February 2024. Pre- and postoperative electrocardiogram-gated cardiac computed tomography angiography was available in 11 patients and analyzed using a workflow analogous to transcatheter aortic valve implantation planning. Measurements included left ventricular outflow tract area, annular geometry, sinuses of Valsalva and sinotubular junction dimensions, coronary height, prosthetic valve angle, and valve-to-coronary/valve-to-aorta distances. Transthoracic echocardiography was performed in all patients.

Results: Annular area increased significantly (3.9 ± 0.7 to 4.6 ± 0.6 cm²; p = 0.014), with enlargement of the sinuses of Valsalva and sinotubular junction area, while left ventricular outflow tract area was unchanged. Mean valve-to-coronary distance was 7.9 ± 2.0 mm for the left coronary artery and 6.4 ± 1.4 mm for the right coronary artery; no computed tomography angiography-evaluable case met the established high-risk thresholds of valve-to-coronary distance ≤4 mm or valve-to-aorta distance ≤2 mm. Thirty-day mortality was 0%.

Conclusions: Postoperative computed tomography angiography demonstrated aortic root enlargement without clinically meaningful prosthetic valve angulation or reduction in valve-to-coronary/valve-to-aorta distance below established high-risk thresholds. These preliminary findings may provide anatomical information relevant to future valve-in-valve planning, although larger studies with longer follow-up and valve-specific simulation data are required.