The pulmonary root is excised by cutting into the muscle of the right ventricle below the level of the valve leaflets. This leaves a narrow rim of muscle tissue around the inflow end of the pulmonary valve that is used for sewing later. The left anterior descending (LAD) branch of the left coronary artery circles the pulmonary root as it heads down toward the bottom tip (or apex) of the heart. The close proximity of the LAD makes careful and gentle excision of the pulmonary root imperative.

With the pulmonary root removed, both coronary arteries are exposed. The harvested pulmonary root is placed next to the heart in the pericardium until needed.