To ascertain if the operative technique has any influence on outcome, the surgical results after aortic root replacement using either a composite valve graft (CVG) or a separate graft and valve (SVG) were analyzed. Eighty-four patients received a CVG, and 36 had SVG replacement. The operative mortality rate was 6% for patients receiving a CVG and 3% for SVG replacement (nonsignificant). Follow-up extended to 21 years (mean 124 ± 45 months). The type of the procedure (SVG versus CVG) was not a significant predictor of in-hospital mortality, length of hospital stay, subsequent root dilatation (SVG), anastomotic dehiscence and subsequent surgery. The early and long-term results after CVG or SVG were similar, which reflects proper patient selection.