A Y Incision and Rectangular Patch to Enlarge the Aortic Annulus by Three Valve Sizes.

For a fifth-time redo aortic valve replacement, a Y incision was made through the left-noncommissure post into the aortomitral curtain above the mitral annulus, undermining the aortic annulus below the nadirs of left coronary and noncoronary cusps without violating the left atrium or mitral valve. A rectangular Hemashield (Maquet Cardiovascular, San Jose, CA) patch was used to extensively enlarge the aortomitral curtain. The aortic annulus was increased from 21 mm to 27 mm for a mechanical aortic valve replacement. The patient was discharged without blood transfusion or any complications. Our enlargement technique was simple and effective to enlarge the aortic annulus for mechanical aortic valve replacement.