biostudies-literatureBonini MNHLBI NIH HHSNational Institutes of HealthNIH HHS876-887https://www.ebi.ac.uk/biostudies/studies/S-EPMC12436585biostudies-literatureUnknown18(4)Y-incision aortic annular enlargement (Y-AAE) with surgical aortic valve replacement (SAVR) may improve outflow tract hemodynamics and valve-in-valve (ViV) outcomes but could increase thrombosis risk. We used computational fluid dynamics to analyze post-operative hemodynamics in 15 patient-specific SAVR models, comparing cases with and without Y-AAE. ViV scenarios were simulated by virtually deploying transcatheter aortic valves. Transvalvular peak velocities, pressure gradients, and blood residence time (a proxy for hemostatic risk) were analyzed to assess performance across cases. Y-AAE reduced peak velocity by 39.3% (55% in ViV), transvalvular pressure gradient by 87.2% (92% in ViV), and mean blood residence time by 10.3% (14% in ViV), with no consistent difference in maximum residence Journal of cardiovascular translational researchModeling the Hemodynamic Impact of Y-incision Aortic Annular Enlargements on Aortic Valve Replacement and Valve-in-Valve Procedures.PMC12436585R01HL141891R01 HL141891R01 HL151776R01HL151776Bonini MSanjay SMonaghan KNordsletten DBalmus MMakkinejad AHirschvogel MYang BBurris NfalseModeling the Hemodynamic Impact of Y-incision Aortic Annular Enlargements on Aortic Valve Replacement and Valve-in-Valve Procedures.Y-incision aortic annular enlargement (Y-AAE) with surgical aortic valve replacement (SAVR) may improve outflow tract hemodynamics and valve-in-valve (ViV) outcomes but could increase thrombosis risk. We used computational fluid dynamics to analyze post-operative hemodynamics in 15 patient-specific SAVR models, comparing cases with and without Y-AAE. ViV scenarios were simulated by virtually deploying transcatheter aortic valves. Transvalvular peak velocities, pressure gradients, and blood residence time (a proxy for hemostatic risk) were analyzed to assess performance across cases. Y-AAE reduced peak velocity by 39.3% (55% in ViV), transvalvular pressure gradient by 87.2% (92% in ViV), and mean blood residence time by 10.3% (14% in ViV), with no consistent difference in maximum residence 2025-01-01T00:00:00Z2025 Aug2026-06-02T05:51:46.948Z2026-04-14T03:14:02.125ZS-EPMC124365854050054710.1007/s12265-025-10634-x