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Annulo-aortic ectasia has attracted much surgical attention in the last 20 years. Replacement of the aortic valve and ascending aorta from the valve ring to just proximal to the innominate artery eliminates most, if not all, the pathologically involved tissue. Composite valve-Dacron tube grafting, plus elective saphenous vein grafts from the coronary orifices to the Dacron tube or distal aortic wall, provide a safe systematic approach to this entity. A review of surgical techniques and a description of a successful case employing this method are presented.