While modern prostheses for aortic valve replacement provide a good substitute for the diseased aortic valve, they are still associated with a small but significant risk of complications. Thus, preservation of the native undiseased aortic leaflets during aortic root replacement is particularly attractive, especially if the repair is durable. Thorough understanding of the anatomy of the aortic valve and adjacent structures as well as the pathogenesis of aortic regurgitation in diseases of the aortic root is mandatory to the successful implementation of valve sparing aortic root repairs.