After opening the aorta, three stay sutures are applied to achieve a better exposure. The valvular leaflets and the calcified annular tissue are then removed, and pledgeted periannular sutures are applied. The annular size is then evaluated and the right sized mechanical valve is then chosen. The periannular sutures are passed in the prosthetic stent, the valve is positioned into the aortic annulus, and the stitches are tied. Another stitch is applied to avoid a paravalvular leak and the correct opening of the mechanical leaflets is checked. The aortic wall is closed with 2 continuous sutures.