In a less invasive surgery, the surgeon may make an incision between the ribs. The surgeon uses this incision to work on the heart. The surgeon does not cut the sternum.

In an open-heart surgery, the surgeon opens the chest with a retractor to expose the heart. The surgeon opens the lining that protects the heart (pericardium).

Next, the surgeon removes the damaged aortic valve.

Finally, the surgeon inserts the replacement valve into the aorta. The replacement valve may be either mechanical or made of animal tissue. The surgeon sews the valve to the annulus, which is a ring of tissue that connects to the leaflets of the aortic valve.