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 three commissural sutures are applied. The annular size is then evaluated and three orientation sutures are placed at the nadir of every aortic sinus, equally distant from the commissures. The right sized sutureless valve is then chosen and the orientation sutures are passed in the prosthetic stent, the valve is positioned into the aortic annulus, balloon-expanded and deployed. The orientation stitches are tied and the aortic wall is closed with 2 continuous sutures.