Aortic valve regurgitation in conjunction with ectasia of the proximal aorta is a common finding. The pathologic mechanism of valve insufficiency is mainly caused by dilatation of the aortic root at the level of the sino-tubular and the aorto-ventricular junction. Total replacement of the proximal aorta with resuspension of the aortic valve within the graft is a new alternative approach. Between July 1993 and March 1995, 17 patients were treated for root ectasia using this approach. The age ranged from 15 to 70 years. Aortic insufficiency (mean grade 3) was present in all patients. The operation consisted of total replacement of the proximal aorta with resuspension of the native valve within the graft. In five patients the aortic arch was replaced as well, one patient underwent mitral reconstruction for severe mitral regurgitation. There was no mortality; postoperative aortic regurgitation was reduced to a mean of 0.7. Aortic valve function has been stabled in 16 instances, in one patient a mild increase in regurgitation was seen. Aortic valve reconstruction in conjunction with total tubular graft replacement of the proximal aorta is a new alternative approach for patients with root ectasia. The disadvantages of mechanical heart valve replacement can be avoided.