Technique for replacing the ascending aorta and aortic valve with a modified Bentall's operation

Composite graft replacement of the aortic root and valve poses the challenge of reimplanting both coronary ostia. The technique of sandwiching the freed button of aortic wall bearing the coronary artery ostium between an outer Teflon felt washerlike buttress and the inner composite graft provides a leak-proof anastomosis while reestablishing direct graft to coronary artery continuity regardless of the location of the coronary ostia or type of root pathology.