Objective <p>We aimed to evaluate the long-term outcomes of long-interposed graft replacement of the left coronary artery (Svensson’s modification) in the modified Bentall procedure compared with button reconstruction using propensity score matching analysis.</p> Methods <p>In total, 101 patients who underwent the modified Bentall procedure with Svensson’s modification (S group, n = 54) or button coronary artery reconstruction (B group, n = 47) between 1992 and 2024 were included. In the first era, we routinely performed Svensson’s modification; recently, the procedure was performed when mobilization of the left coronary artery was difficult.</p> Results <p>The median age was relatively lower in the S group (63.0 [50.5–68.8] years) than in the B group (66.0 [56.5–1.83] years). There were no significant differences in in-hospital mortality between the two groups, with two deaths recorded in each group. Five and four patients in the S and B groups, respectively, required additional intraoperative and postoperative interventions for button-reconstructed coronary arteries. In the long-term, both groups had no additional interventions for the reconstructed coronary ostia. In the S group, overall survival rates were 78.2, 67.6, and 60.8% at 10, 15, and 20&#xa0;years, respectively, and the reoperation rates were 14.2, 18.3, and 18.3% at 10, 15, and 20&#xa0;years, respectively. Propensity score matching showed no significant differences in in-hospital mortality, overall survival, or reoperation rates between both groups.</p> Conclusions <p>Svensson’s modification of the Bentall procedure provided good long-term outcomes, equivalent to those of button reconstruction; it may provide good outcomes in patients with difficult mobilization of the left coronary artery.</p>