Modification of the David procedure for reconstruction of incompetent bicuspid aortic valves

The David procedure was described primarily to treat tricuspid valves. The asymmetry of the bicuspid root asks for modifications to achieve a competent bicuspid valve. The most common feature of the bicuspid valve is the presence of left and right coronary rudimentary cusps. In this case usually the base of the noncoronary cusp is displaced toward the left ventricular outflow tract. The uneven plane of this type of bicuspid aortic annulus has to be compensated for when a rigid prosthesis is wrapped around the aortic root. We describe the modification of the David technique in 14 patients who underwent a valve-sparing aortic root replacement in presence of a bicuspid valve. This technique increases the coaptation surface and provides reliable early and mid-term competence of the reconstructed bicuspid aortic valves.