Ascending aortic aneurysms involving the aortic root are usually treated with replacement of the ascending aorta and the aortic valve using a composite valved conduit. However, the aortic valve is usually normal and the dysfunction is due to an impairment of the other components of the aortic root. In these cases, the aortic root can be replaced, sparing the native aortic valve. Aortic valve-sparing operations have been demonstrated to be effective and durable. This article summarizes the principal methods of valve-sparing procedures, and describes the advantages and disadvantages of each method, and their impact on patient outcomes.