IntroductionThe unicuspid aortic valve is an aortic valve variant present in 0.02% of population. It associates dilated ascending aorta and the usual treatment is aortic valve replacement because it comes with unstructured tissues. We present this video that we made a conservative aortic valve surgery transforming a unicuspid valve into bicuspid valve as an alternative to prostheses implantation. Materials and methodsA 40-year patient with unicuspid aortic valve, aortic regurgitation grade IV and aortic root dilatation. Retrospective analysis of 8 patients with unicuspid aortic valve and conservative surgery (2011-2015). ResultsIn the video is done: annuloplasty, bicuspidización with pericardium and aortic root remodeling (YACOUB). After surgery, aortic regurgitation was grade I.The group showed: mean age 37.5±11.2 years, 1 (12.5%) woman; EuroSCORE Logistic 5.6±2.5; EuroSCORE II 1.9±1.2. Procedures performed: aortic valve reimplantation (DAVID) + aortic plasty 4 (50%); aortic remodeling (YACOUB) + aortic plasty 3 (32.5%); isolated aortic plasty (tricuspidization) 1 (12.5%). The preoperative aortic regurgitation of the group: II (12.5%), III (12.5%) and IV (75%). Mean follow-up was 9.6±7.3 months (median 8.71). There was no exitus. The 87.5% are free from aortic regurgitation. Only the patient where the isolated aortic plasty was performed the regurgitation evolved from mild to grade III during follow-up. ConclusionsUnicuspid aortic valve repair is possible with clinical and echocardiographic good results.