Video 1 This is a standard case of aortic valve regurgitation of a 65 years old female, with known disease since 2008 and symptomatic in functional class II. At the echo valved looked bicuspid. The operations scheduled was aortic valve replacement with a tissue valve (actually was a CE num 19) through a J sternotomy. An innovative device composed by two staples, called RAM® and the other SEW-EASY®, was intended to use for suturing the prosthesis. Also, the use of another well-known device, aimed to tied suture, called COR-KNOT® was established. After central cannulation and selective delivery of cardioplegia, aortic cusps are resected. With the RAM® device the two ends of the tread with the Teflon pledget are passed equidistant in the aortic annulus, after previous loading of the stitch in to the device. Then, with the called SEW-EASY® device, stitches are also symmetrically passed thought the sewing ring of the prosthesis. After the prosthesis is parachuted, the COR-KNOT® device was used to finally tied the stitches. The intraoperative echo showed well positioned prosthesis, without paravalvular leak.