The preservation and repair of the aortic valve, since its valve annulus and leaflets have anatomically complicated 3-dimensional structures, is technically demanding with challenging aspects, and has not been a general surgical treatment, yet. However, in the recent trend of sparing and repair of the native valves in the cardiac surgical field, for aortic root diseases in relatively younger patients, valve sparing aortic root replacement has been attempted with the favorable outcome. In terms of its indication, such technically demanding surgeries had previously been indicated predominantly for patients without any valve deformities and significant aortic valve regurgitation, however in recent years, through the expanding indication with technical advances, they have been performed even for cases with some valve deformities including regurgitant bicuspid aortic valves. In this section, an up-to-data review would be described on valve sparing aortic root replacement, including its current indication, surgical techniques, and recent topics for discussion.