Valve replacement and homograft remain the “gold standard” for treating patients with severe aortic valve disease. For successful procedure, as well as in correction of left ventricular outflow tract obstruction, it is necessary to ensure optimal access and visualization of ascending aorta, aortic valve, interventricular septum and subvalvular structures. The key factor for successful surgery is a thorough understanding of aortic root anatomy and selection of appropriate aortotomy based on surgical plan and structures to be visualized. In this article, we discuss the main anatomical aspects of aortotomy and the most appropriate techniques for different clinical situations.