This procedure, a variation of the original Bentall procedure, is a simultaneous replacement of the aortic valve, root and the entire ascending aorta. A composite Dacron graft, which includes the new valve bioprosthesis or prosthesis, is put in place. Then, the coronary arteries are implanted in the Dacron graft using aortic buttons. This procedure is typically required in severe connective tissue disorders such as Marfan syndrome. It also is indicated whenever there is a combined dilation of the aortic root and annulus, as well as the ascending aorta.