Background: Dehiscence of a composite graft following aortic valve (AV) and ascending aorta replacement represents a rare but potentially life-threatening complication. The need for re-operation after a Bentall procedure is usually related to the development of an endocarditis, formation of (pseudo)aneurysms, or recurrent dissection. We report a rare case of late pseudoaneurysm formation due to Case summary: A 52-year-old man was admitted to the emergency department due to dizziness, diplopia, right-sided hemiparesis, and dysarthria. Five and a half years ago, the patient underwent a replacement of the AV and entire ascending aorta due to a bicuspid AV with combined valvular disease and ascending aortic aneurysm. Transthoracic echocardiography revealed a large, perfused posterior pseudoaneurysm caused by the dehiscence of the composite graft, while the mechanical valve remained well functioning. After 8 days of incubation, Discussion: The dehiscence of a composite graft is a rare but serious complication following AV and aortic replacement with a high mortality.