The David procedure for quadricuspid aortic valve repair.

Quadricuspid aortic valves are rare but may result in significant aortic regurgitation requiring surgery. To date, valve-sparing root replacement is frequently done in patients with bi- and tricuspid aortic valve pathologies with preserved cusp tissue. Nevertheless, little is known about quadricuspid repair, especially in regard to the optimal surgical technique for long-term durability. We hereby provide a surgical guide to valve-sparing aortic root replacement using the David technique in a young patient with severe aortic regurgitation.