FIG 58.7 Bicuspid aortic valve plication in valve-sparing aortic root replacement (From Vricella LA, Cameron DE Valve-sparing aortic root replacement in pediatric patients: lessons learned over two decades Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017;20:56–62.) Aortic Arch Repair Most children will not require aortic arch repair at the time of valve-sparing aortic root replacement However, some children with more severe CTD phenotypes and large arches may require both aortic root and arch replacements Arch replacement is typically performed under deep hypothermia (