Modified Bentall procedure - 'a collar technique' to control bleeding from coronary ostia anastomoses

Composite conduit aortic root replacement has become widely accepted as the preferred treatment for ascending aorta aneurysm and dissection. We present a patient in whom creation of 'buttons' was impossible due to fragility of the ascending aorta wall. The distal anastomosis was made to the transected aorta. The remnant of the proximal ascending aortic wall was fully transected 8-9 mm above the upper edge of coronary ostia anastomoses (incorporated into conduit using inclusion technique), thus forming a 'collar' around the proximal part of the conduit. At the end of the procedure the 'collar' was anchored to the conduit to control persistent bleeding from coronary ostia anastomoses.