Repair of Asymmetric Bicuspid Aortic Valve Using Tricuspidation with CardioCel

We present a novel technique for tricuspidation of the very asymmetrical bicuspid aortic valve (AV) with commissural orientation of about 120-140, via replacement of the fused AV cusp with 2 neo-cusps. The neo-cusps are fashioned from bovine pericardium and sutured to the annulus. Successful repair using the described technique requires good quality and adequate commissure height of the non-fused cusp. Since 2020, this technique has been applied to 15 patients. To date, all patients are alive with well-functioning AVs, presenting no or trivial insufficiency, large orifice areas, and nearly physiological transvalvular gradients.