This is why Ross, upsized Bentall, Ozaki and Y-AAE work so well for valvular AS without enlarging the LVOT. The LVOT is normal in AS patients. NO need to enlarge the LVOT. subaortic web and HOCM are different diseases, can be treated with web resection and myectomy.

With complete transaction of the ascd aorta for Y-AAE, it is very easy to access the MV through the dome of LA since MV is right underneath the root. This approach can be used for concomitant MV repair, replacement or LA Maze, LAA excision.

We will have a hands-on wet lab of Y-incision AAE at EACTS in Copenhagen. Feel free to sign up. https://t.co/2mDh6xLL60

Deep dissection is critical to achieve a competent aortic valve in David procedure. It can be challenging when the R cor sinus is ventricularized and VAJ is high. This video shows how to perform deep dissection without worry about RVOT injury for perfect David procedure.

A lot of excitement at EACTS this year

Congrats to our graduated aortic fellow, Dr. Candis Jones. Great job and fantastic case log. A bright future is waiting for you!!

Y-incision AAE has been criticized not enlarging the basal ring/LVOT. Nor does Ross, Bentall, Ozaki procedure. All four techniques place a valve with large opening above the LVOT with great hemodynamics. Y-AAE is the simplest and prepare for TAVR. AV stenosis is not LVOT stenosis

This study emphasizes the importance of aortic annular/root enlargement during SAVR to implant size 27-29 valves to avoid PPM, PVL and slow down SVD (larger EOA at implantation). TAVR can’t enlarge the aortic annulus/root. Surgeons need to do more AAE in SAVR.

Using a mitral composite valve graft with a sling to enlarge both mitral and aortic annuli by 3 valve sizes - JTCVS Techniques. Simpler and more effective than Commando. Does not obstruct the LVOT. Great potential for future TMVR and TAVR if needed. https://t.co/FWBRrdRFzZ

A podcast by EACTS on Y-incision aortic annular enlargement: Expanding Aortic Roots and Surgical Horizons

Michigan Aortic Club at STS 2025! Very proud of our graduated fellows and current fellow

We made Arc modification of Y-AAE to avoid the tensing of the suture line of the patch to the aorta-mitral curtain (a bar below the valve). It maintains most aorta-mitral curtain, the flexibility of the aortic root, the shape of the basal ring. https://t.co/0Mg8hdNVoa

Wrapping up #OkitaAortic with a fantastic #Tokyo evening boat ride - amazing fun with unbelievable camaraderie from the #aortic greats. Thank you for the opportunity and privilege to be the #SoMe ambassador!

Last case with our aortic fellow, Ken Hassler. Congratulations, Ken, a bright future is waiting for you!!

The application for aortic fellowship at Michigan will open soon

I showed this case to leaders in cardiology. Their comments are this is good results. But most surgeons in the US would put a size 19 or 21 for this pt. Not sure that is better than TAVR.

Explanted 23 sapient, enlarged the annulus from 19 to 25. The opening of old TAVR valve was < 1/3 of the new SAVR valve. coronary Ostia were above the SAVR valve. Aortic annular enlargement should be routine in SAVR like LIMA in CABG, especially in redo SAVR after SAVR or TAVR.

We enlarge the crown shape annulus and root liberally. All my fellows mastered this technique. But I don’t put size 29 in every pt. Some gets 25 or 27 which matches the native annulus of 19-21mm. When the LCA ostium is low, <5 mm, downsize from the largest size by 1 valve size.

Explanted 23 sapient, enlarged the annulus from 19 to 25. The opening of old TAVR valve was < 1/3 of the new SAVR valve. coronary Ostia were above the SAVR valve. Aortic annular enlargement should be routine in SAVR like LIMA in CABG, especially in redo SAVR after SAVR or TAVR.

Thank you all for your excellent contribution!!