Bo-Yang Y-Incision Aortic Root Enlargement in Indian Patients Undergoing Surgical Aortic Valve Replacement: A Prospective Single-Centre Feasibility Series of 33 Patients.

OBJECTIVE: Lower body surface area predisposes Indian patients to small aortic annuli and prosthesis-patient mismatch (PPM) after surgical aortic valve replacement, increasing late mortality. The Bo-Yang (Y-incision) technique enlarges the posterior aortic root through the aortomitral curtain and fibrous trigones, sparing the anterior mitral leaflet and conduction system, but Indian data are lacking. METHODS: We prospectively enrolled 33 consecutive adults with severe aortic stenosis and small annuli (≤22 mm) undergoing SAVR with BYARE at a single Mumbai centre (2024-2026). Primary endpoints were 30-day mortality and predicted risk of PPM (predicted iEOA <0.85 cm2/m2, not measured postoperatively); secondary endpoints were annular upsizing, early extubation, and complications. RESULTS: Patients (17 men, 16 women; mean age 53.9 ± 12.9 years; mean BSA 1.77 ± 0.19 m2) were all NYHA class ≥III, with 7 (21.2%) redo sternotomies. Mean annular diameter was 19.7 ± 1.8 mm and prosthesis size 23.8 ± 1.9 mm (upsizing 4.1 mm). Early extubation (<6 hours) occurred in 90.9% of patients, with no 30-day mortality, no paravalvular leak, and no patient predicted to be at risk of clinically significant PPM (mean predicted iEOA 1.01 ± 0.17 cm2/m2). CONCLUSIONS: BYARE is technically feasible and associated with favourable early outcomes in a heterogeneous Indian cohort, facilitating annular upsizing and minimising predicted PPM risk. PPM was estimated, not measured, and longer-term multicentre evaluation is needed to confirm durability.