Alexander Chee-Wong
Research Mentor(s): Bo Yang
Mentor Department: Cardiac surgery
Authors: Barbara Hamilton, Francis D. Pagani, G. Michael Deeb, Gorav Ailawadi, Himanshu Patel, Jonathan W. Haft, Karen Meekyong Kim, Matthew A. Romano, Paul Chun Yung Tang, Robert Bruce Hawkins, Shinichi Fukuhara, Alexander Chee-Wong, Jessica Woodford, Marc Titsworth, China Green, Bo Yang
Session: Session 1 (9:00am – 9:50am)
Presentation Type: Poster 108
Abstract
Aortic annular enlargement (AAE) is increasingly performed during surgical aortic valve replacement to facilitate the implantation of a larger prosthetic valve and improve valve hemodynamics. Suboptimal hemodynamics can lead to prosthesis-patient mismatch (PPM), which can contribute to increased morbidity, earlier valve deterioration and subsequent reintervention. Classical AAE techniques, including Nicks and Manouguian, have been long-established to enlarge the annulus by one to two valve sizes without significant increases in postoperative morbidity or mortality. More recent short-term studies of the Y-incision technique suggest it may achieve a greater annular enlargement—often three to five valve sizes above native in order to optimize future transcatheter aortic valve replacements—and reduce the incidence of severe PPM at one-year follow-up. However, the long-term outcomes of the Y-incision have yet to be elucidated. To address the knowledge gap, our team at Michigan Medicine has developed a specialized AAE patient database of those who have undergone AAE procedures between January 2014 and September 2024. It aims to establish long-term data on Y-incision patients in addition to our Nicks and Manouguian cohorts. The database follows standardized metrics set by the Society of Thoracic Surgeons and integrates patient information through retrospective chart review using MiChart and EMERSE, while long-term survival is tracked by the Michigan Death Index. REDCap serves as the primary platform for data management and longitudinal collection. Collectively, the database enables systematic tracking of preoperative demographics, hemodynamic performance, and long-term survival. By integrating the three AAE procedures into one centralized database, the database offers a broad repository for future cohort studies and comparative analyses. The overarching goal of the initiative is to provide a versatile, large-scale resource to advance knowledge within AAE surgery and inform evidence-based improvements in patient care.
