(A) The arterial cannula has already been moved to the Hemashield^®-tube graft, which has been anastomosed to the distal ascending aorta. The Freestyle^® porcine valve is used to replace the aortic root. The right coronary button is anastomosed to the appropriate position on the Freestyle^® valve. (B) The Freestyle^® valve is anastomosed to the Hemashield^®-tube graft with running 4-0 Prolene^®. This is the only additional step required compared to using a mechanical valve conduit. (C) The completed composite replacement of the aortic valve, root, and ascending aorta is shown.