Allograft aortic valve replacement for bicuspid aortic valves with 180-degree coronary ostia

Congenital bicuspid aortic stenosis is often an indication for aortic valve replacement in young adults and children. However, when the coronary ostia are exactly 180 degrees opposite each other, placing a trileaflet human allograft with freehand technique can be difficult. The described technique enlarges the left ventricular outflow tract beginning at the annulus level, using only allograft tissue. In addition to allowing placement of a larger allograft, this method rotates the coronary ostia toward each other, converting the aortic root to three-sinus anatomy.