Anatomy (real anatomy) of the aortic valve replacement: when we can actually see it

Ross procedure,1 aortic valve sparing operations, homograft placement, Bentall procedures and even standard aortic valve replacement can damage the atrioventricular bundle, the membranous septum or the blood supply of the atrioventricular node.2 For instance: the first “dogma” instructed to a resident in aortic valve replacement is: “Do not put any stitches under the annulus: if you do this, the patient can develop atrioventricular block”. The fact of the matter is that there is no aortic annulus, and when a stentless valve has to be placed in the “annulus” the sutures HAVE to be placed in an annular fashion. So, what is the truth? Where are the atrioventricular node and the His Bundle?