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Ideal prosthetic aortic valve should maintain excellent hemodynamic characteristics that are sustainable during varying hemodynamic conditions and demands, have minimal trans-aortic pressure gradients, should be durable in the long term, resist thrombus formation without the need for anticoagulation and be straightforward to implant. Unfortunately, the ideal prosthetic aortic valve does not yet exist. This review critically evaluates available-to-the-surgeon options.Critical evaluation of relevant literature sources available on PubMed with the emphasis on current situation and new trend in the aortic valve sparing procedures. Current prosthetic devices are associated with complications such as valve thrombosis and thromboembolic events, bleeding events associated with anticoagulation use and structural valve deterioration. Therefore native valve disease is replaced by prosthetic valve disease. Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm and ascending aortic aneurysm with associated aortic insufficiency, circumventing complications arising from prosthetic valve implantation by preserving the native aortic valve apparatus. There are two fundamental types of aortic valve sparing procedures: remodelling of the aortic root and reimplantation of the aortic valve. Evidence based medicine shows that reimplantation of the aortic valve is in long term associated with lower risk of developing aortic insufficiency. An alternative standardized approach that combines an external subvalvular aortic prosthetic ring annuloplasty with remodelling technique was presented. Implantation of an external aortic ring provides a reproducible technique for aortic valve repair with great preliminary results.