Dissect out the aortic root, taking care to recognise the coronaries. Mobilise the MPA.

Transect the aorta/aortotomy. Transect the main pulmonary artery with the suitable length. Visualise the valve leaflets, use a right-angle and bluntly puncture the RVOT free wall with the finger against the tip. Use fine scissors to cut the anterior wall. Use diathermy near the sides and knife on the posterior wall. Check with a Watson-Cheyne the course of the left coronary. If doing the Elkins modification, leave the back wall in continuity with the LCA origin, and dissect out the coronary. Cut out the valve leaflets. Dissect out the right coronary. Give plegia and check where the bleeding points are on the back wall. Single 5-0 anastomosis. Oversewn with 6-0. LCA anastomosis to the autograft which has the posterior sinus cut out, leaving both ends on a shod as they come up to close the aorta. Hole for RCA created with knife, fine scissors. 6-0. Then close the rest of the aorta. Distal end of the homograft to PA. Proximal end to RV, single layer. XC off.