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Distal aortic disease may evolve in Marfan patients after aortic root surgery. The aim of this study was to analyze the results of distal aortic reoperations in Marfan patients after proximal aortic surgery.A total of 95 Marfan patients (56 male; mean age 34.5 ± 10.9 years) have been followed or operated on at our institution between October 1994 and December 2007. Results of patients who required distal aortic reinterventions after root surgery were collected and analyzed.Fifteen Marfan patients (9 male; mean age 39.1 ± 7.5 years) underwent distal aortic reinterventions after aortic root surgery. The indications for distal reoperations consisted of dissecting aneurysm after type A dissection surgery in 12 patients (80%) and nondissecting aneurysm in 3 patients (20%). Type A dissection during initial aortic root surgery was the only independent predictor of distal aortic reoperation (hazard ratio 3.8). One patient (6.7%) died perioperatively. Neurologic morbidity consisted of 1 patient with paraplegia and 1 with temporary paraparesis, and no strokes. Two patients died during a mean follow-up of 36.2 ± 25.5 months. Survival was 91.7% ± 1.6% at 1 and 5 years postoperatively. Three patients undergoing reoperative arch procedures required additional interventions on the distal aorta during follow-up.Distal aortic reoperations in Marfan patients are more common among those presenting with type A dissection. Although technically challenging, such procedures can be performed with good short- and long-term results. Complete aortic arch replacement with an elephant trunk technique, if it can be safely performed, should be considered for Marfan patients presenting with type A dissection.