Methods: The study included 13 patients (11 males, 2 females; mean age 53.54±16.09 years; range 22 to 75 years) with aortic aneurysm and aortic root enlargement who underwent aortic root replacement with flanged composite grafts between January 2010 and January 2014. Nine patients had aortic valve insufficiency, two patients had mix lesions, and two patients had normofunctional bicuspid valves. Double sewing proximal anastomosis technique was performed in all patients. Coronary ostiums were prepared as button style and anastomosed to opened holes on the graft. Ostial anastomoses were tested with antegrade blood cardioplegia infusion before distal anastomosis of the graft was performed.

Results: There was no mortality. None of the patients required re-cross clamping due to bleeding. Two patients underwent revision due to bleeding; however, these bleedings were not related to proximal anastomosis or coronary button sites. Only one patient was discharged with mild neurological sequela while other 12 patients completely recovered.

Conclusion: Flanged-double sewing proximal anastomosis technique may minimize the risk of bleeding from this line. Also, controlling ostial anastomoses with antegrade blood cardioplegia prior to cross clamp removal may effectively prevent challenging bleedings in aortic root replacements.