Minimally Invasive Bicuspid Aortic Valve Repair Using Geometric Ring Annuloplasty

A 51-year-old man with congestive heart failure, Sievers type 1 bicuspid aortic valve, and severe aortic insufficiency had an upper mini-sternotomy. The annulus was sized to 27 mm, and the nonfused cusp to a 21-mm bicuspid ring. Using the geometric annuloplasty ring, two 180° subcommissural ring post sutures, 3 nonfused looping annular sutures, and 4 fused annular sutures were placed. Plication sutures raised noncoronary leaflet to a reference effective height of 10 mm, and fused leaflet cleft was closed linearly to the same effective height and length. Post-repair echocardiography showed good leaflet mobility, no residual leak, and a mean valve gradient of 10 mm Hg.