Sievers type 1 RL, which is asymmetric but can fit into the 180-degree paradigm.A novel bicuspid aortic valve classification moves beyond current descriptive classification systems toward a prescriptive guide invoking symmetry as the answer to geometric complexity.See Article page 83.As experience in aortic valve repair has lagged somewhat behind surgical repair of the mitral valve, there has been a trend toward analogizing the 2 pathologies. Conceptually, there has been utility in this strategy by categorizing different modes of aortic insufficiency, thereby organizing the various approaches to repair. The classification system developed by Dr El Khoury 15 years ago shifted the classification paradigm beyond purely morphological descriptions by correlating functional phenotype with repair techniques. With further expertise in aortic root physiology and phenotypes, it has become apparent that there are 3-dimensional complexities to aortic valve repair that begin to muddle the mitral repair analogies. This may be most apparent in bicuspid valves, as described by the Brussels group. The authors should again be congratulated for developing granularity in their classification system beyond the presence and location of cusp fusion and elaboration of the associated repair strategies.The authors further categorize bicuspid valves based on the commissural orientation into 3 categories spanning the spectrum from 120 degrees to 180 degrees. Notably, the distribution of cusp fusion (RL, RN, LN) was equal among the symmetric, asymmetric, and very asymmetric phenotypes, implying that the widely used Sievers classification is less useful for identifying that type of repair technique that should be used. In addition to the CO, geometric heights of the cusps, length of raphe fusion, and raphe heights are all variables to be accounted for intraoperatively when deciding on a repair strategy—a potentially daunting number of variables for the less experienced. The solution to these complexities is to simplify the geometric conundrum by recreating symmetry around the nonfused “normal” leaflet. The 180-degree reimplantation technique as the authors describe facilitates circumferential symmetry at the levels of the ventriculoaortic junction and the neo-sinotubular junction and vertical symmetry of the commissures and cusp nadirs. Final adjustments to leaflet free margin length can then be made by plication or closure of an incomplete raphe.This concept of 180-degree symmetry is applicable to the majority of bicuspid aortic valve repairs. However, in a portion of very asymmetric valves—particularly the BAV “fruste” phenotype—strategies diverge from the 180-degree reimplantation technique. Again, symmetry remains the underlying theme, this time around a trileaflet configuration by using commissurotomy and resuspension techniques.The specifics of commissural geometry and cusp fusion are important to the advancement of bicuspid aortic valve repair. The authors are to be extolled for their insights. The framework of recreating 3-dimensional symmetry is the theme for moving toward a “true” bicuspid repair strategy.