Minimally invasive aortic valve replacement using a bioprosthesis in a young adult with Wunderlich syndrome and bicuspid aortic valve

We report the case of a 20-year-old male with a history of Wunderlich syndrome and prior partial nephrectomy, who was referred for cardiovascular surgery evaluation due to severe aortic regurgitation. Transthoracic echocardiography revealed bicuspid aortic valve type 1 with right-left cusp fusion and cusp prolapse, preserved left ventricular function (LVEF 55%), and marked left chamber enlargement. Given the patient's history of major bleeding, a mechanical prosthesis was contraindicated. He underwent minimally invasive aortic valve replacement through upper mini-sternotomy with implantation of an Inspiris Resilia® #25 bioprosthesis and aortic reconstruction with pericardial patch. The postoperative course was uneventful, with adequate hemodynamic stability, no major complications, and early discharge. This case highlights the importance of individualized prosthesis selection in young patients with contraindication to anticoagulation, and the role of minimally invasive approaches in reducing morbidity and hospital stay while enabling future Valve-in-Valve strategies.