The outlook for Marfan patients changed overnight in 1968 with the publication of an article by Bentall and DeBono of London describing their composite graft replacement of the aortic root. With the availability of this new operation, surgical results in major cardiac centers around the world immediately improved so that the operative mortality for Marfan patients undergoing this operation dropped to 5% or less. As noted in this illustration, Bentall placed a ball valve in the proximal end of a fabric graft, removed the patient’s aortic valve and slid the composite graft down to the aortic annulus; he then created side-to-side anastomoses between the graft and the two coronary ostia.

Bentall H & DeBono A. A technique for complete replacement of the ascending aorta. Thorax 1968;23:338-9