From September 1976 to January 1991, 66 patients were operated on for aneurysms of the ascending aorta with aortic regurgitation. The indication for operation was annuloaortic ectasia in 40 patients (61%) and aortic dissection in 26 (39%). Twenty-seven patients (41%) had the classical Marfan syndrome. The surgical techniques employed in this series included separate graft valve replacement (separate G/V) in 18 patients whose coronary ostia were normally placed, and composite graft replacement with coronary reimplantation (composite G) in 48 patients whose coronary ostia were displaced cephalad by the aneurysm. Nineteen patients (29%) had the concomitant operative procedures including aortic arch replacement and mitral valve repair. The early death within one month after the operation occurred in 6 patients (9.1%) comprising 2 (7.1%) in the separate G/V group and 4 (8.3%) in the composite G group. The 10-year survival rate including early death was 77% for the whole series, 70% for the separate G/V group and 79% for the composite G group. There was no significant difference in long term survival rate between the separate G/V and composite G groups. No patients required reoperation for the ascending aorta and the aortic valve in the both groups. However, six patients required subsequent operation for aneurysmal disease or dissection of the remaining thoracic and abdominal aorta. The 10-year event free rate of reoperation was 82% for the whole series, 93% for the separate G/V group and 79% for the composite G group. There was no significant difference in the reoperation event free rate between the separate G/V and composite G groups.(ABSTRACT TRUNCATED AT 250 WORDS)