**10. Valve sparing aortic root replacement**

Sparing the patient's native aortic valve while replacing the aortic root is an alternative option in selected patients [54]. This naturally avoids need for anti-coagulation [9]. After an initial pre-operative trans-esophageal echocardiogram, the valve leaflets should be examined prior to proceeding with valve-sparing approach. Leaflet quality is fundamental to event-free survival in these patients.
