The Bentall operation is preferred when a diseased aortic valve is associated with a dilated or dissected ascending aorta. Composite valved grafts have been devised to facilitate and expedite this procedure. The initial clinical results of the Bentall procedure using a vascular conduit modified to incorporate "pseudosinuses of Valsalva," with the aim of simplifying coronary button anastomoses and decreasing tension upon them, is described herein. Over a period of 40 months since its introduction, the novel conduit has been used, for a Bentall procedure in 37 consecutive patients. Of this group, 31 were men and 6 were women, with a mean age of 63.8+/-9.9 years. Five were Marfan patients, 8 were patients after acute or chronic dissection, and 8 were patients who required redo procedures. In 22 patients, the modified conduit was used in association with a biological valve (4 stentless valve) and in 15, with a mechanical valve. The mean durations of CPB and X-clamp time were 117+/-32 and 88+/-22 minutes, respectively. No operative or late deaths occurred after a mean follow-up period of 20+/-12 months. This study indicates that the new vascular prosthesis appears to facilitate implantation by maintaining a more natural shape of the reconstructed aortic root.