Comparative Research of Y-Incision vs. Standard Techniques for Aortic Root EnLargement

Inclusion Criteria: * Adults aged 18-80 years. * Patients must have signed and dated an ICF in accordance with regulatory and institutional guidelines before any protocol-related procedures and must be willing and able to comply with scheduled visits. * Diagnosed with aortic valve disease requiring aortic valve replacement. * Patients with small aortic annulus relative to body size where conventional AVR result in moderate or severe PPM (defined as cases where the largest prosthesis that can be implanted in the native annulus would provide a predicted iEOA ≤0.85 cm²/m² for BMI \<30, or ≤0.70 cm²/m² for BMI ≥30), based on manufacturer specifications and patient BSA). * Suitable candidates for surgery as determined by the heart team. Exclusion Criteria: 1. Patients for whom conventional AVR without root enlargement is not expected to result in patient-prosthesis mismatch. 2. Prior cardiac surgery. 3. Severe concomitant valvular disease requiring additional procedures. 4. Active endocarditis. 5. Severe chronic lung disease 6. Pre-existing lower limb deficits or any other medical comorbidities that interfere significantly with gait or the ability to perform exercise testing on a bicycle ergometer 7. Severe left ventricular dysfunction (LVEF \< 30%). 8. Contraindications to surgery. 9. Concurrent active treatment in another clinical trial