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Objectives: Reconstruction of a bicuspid aortic valve mostly requires the use of autologous pericardium for the cusp repair. This again is burdened by the risk of tearing the tissue at the suture line especially, when the stitches are localized at the high stress points. Methods: First, we abandoned suturing the pericardium with the thin and fragile cusp tissue (e.g. after excision of the raphe) and, if appropriate, replaced the entire cusp body with pericardial patches using the annulus, thedoi:10.1093/icvts/ivt372.145 fatcat:vmc7utgzkfbvhce4z62fkw5mae