The first step in any aortic valve operation is to open the aorta and inspect the valve. Blood flow is diverted through the heart-lung machine and the heart is "turned off" during this time. The incision is made just above where the coronary arteries are attached to the aortic root.

This images shows the diseased aortic valve being removed from the aortic annulus. The yellow form, seen arching along and above the rim of the aortic root is the pulmonary artery and root. The aortic valve, in this instance, is bicuspid and heavily scarred. Also visible is the scar tissue still attached to the aortic annulus.

Removal of scar tissue and calcium deposits from the interior surface of the aortic root and annulus is also done at this time.