Aortic valve repair (AVr) and preservation of the native valve in the context of aortic root pathologies, particularly aneurysms, have become sophisticated and preferred alternatives to aortic valve replacement (AVR) in experienced centers. This approach offers superior hemodynamic outcomes, avoids complications associated with mechanical and biological prostheses, and preserves valve vitality. This chapter provides a comprehensive, advanced review of anatomy, physiology, pathologies, diagnostics, and especially complex surgical techniques for repair and valve preservation, focusing on aortic root aneurysm management. Fundamental principles of aortic valve preservation surgery, current techniques (including aortic valve reimplantation [David procedure] and aortic root remodeling [Yacoub procedure]), and complication management are detailed.