The incision initially made to inspect the aortic valve is now continued in a circular fashion to sever the aortic root from the rest of the aorta. The tissue at the base of the aortic root used to be removed but is now preserved for later inclusion around the autograft for external support. The wall of the aortic root around the opening leading to each coronary artery is cut out to sew in as a "button" later. These coronary artery "buttons" will be reattached after the new aortic root is constructed using the autograft - the patient's pulmonary root complete with its valve.

The wall of the aortic root around the left coronary artery (seen oozing blood down the inside wall of the aortic root) is cut out so that it may be integrated into the new aortic root that is fabricated from the pulmonary root. Also of note on the right side of this image is the wide opening left in the right ventricle after removing the autograft. This opening can be measured with cylindrical sizers to determine the optimal size of homograft to thaw.