The first successful replacement of the entire ascending aorta from the aortic annulus to the innominate artery, with reimplantation of the coronary ostia and replacement of the aortic valve was performed on a 57-year-old white male. The patient's lesion was a luetic and arteriosclerotic aneurysm of the ascending aorta plus aortic valvular insufficiency. The ascending aorta was replaced with a woven Teflon graft and the aortic valve with a Starr-Edwards prosthesis using extracorporeal support and cold cardiac arrest. The coronary ostia were attached to the Teflon tubular prosthesis. The patient is well without evidence of thrombosis or embolization 13 months later.