Minimally invasive David reimplantation of bicuspid aortic valve.

The technical details of aortic valve reimplantation as a treatment for aortic root aneurism with or without aortic valve insufficiency has been previously described in several studies (1,2). Variations in the aortic valve reimplantation operation have been developed, with the common goal of achieving not only perfect intraoperative results, but also long-term stability. The Valsalva graft (Vascutek, Inchinnan, Scotland, UK) aims to preserve the long-term performance of the aortic valve (3). It is well known that the occurrence of aortic insufficiency during follow up is dependent on leaflet morphology, satisfactory coaptation length and height and stability of the aorto-ventricular junction (AVJ). In our case presentation (Video 1), we emphasize that perfect reimplantation of the bicuspid aortic valve can be achieved by reimplantation of both main commissures into the new sinotubular junction and 180° orientation of the valve.