Primary vasculitis is a group of chronic non-specific vascular inflammatory diseases characterized by inflammation and necrosis of the vessel wall. The etiology is mostly unknown, but it is generally believed that different infectious agents, environmental and genetic factors can lead to the deposition of immune complexes in the vessel wall or cell-mediated immune abnormalities, resulting in an inflammatory response. Depending on the type, size, location, extent and pathological changes of the involved vessels, various clinical manifestations such as inadequate blood supply to the corresponding tissues and organs can be produced. Clinically, inflammation invades the aortic root, resulting in its dilatation and aortic valve closure insufficiency, commonly seen in large vessel vasculitis such as aortitis (also known as Takayasu), Behcet’s disease (Behcet), and Giantcell arteritis (Giantcell). Large-vessel vasculitis is common in China, Japan and other Asian countries; Behcet’s disease is predominant in Japan, the Middle East and Mediterranean coastal countries, with more reports from China; Giantcell arteritis is mostly reported in Europe and the United States. Clinically, aortic valve insufficiency due to aortitis is not uncommon, and the literature reports its incidence to be 14.5%-20% in patients with aortitis, which is one of the main causes of heart failure due to aortitis. The incidence of arterial damage in leukoaraiosis is generally 1.5% to 2.2%, and because of the rapid development of aortic dilatation, it is prone to rupture and bleeding. Aortic valve mechanical valve replacement (AVR) is the traditional surgical method, but perivalvular leakage is very likely to occur after surgery. A large group abroad has reported a 20% incidence of perivalvular leakage after AVR for aortitis, with a very poor prognosis. The mechanism of occurrence of aortic valve insufficiency due to aortitis is not fully understood. Kerr and Nakano et al. suggested that inflammation of the ascending aorta or aortic annulus can cause aortic root dilatation and produce aortic regurgitation. A study of heart valves in 290 hospitalized patients with aortitis at Fu Wai Hospital found that aortic valve insufficiency is closely associated with aortitis involving the aortic root and may also be accompanied by direct invasion of the valve leaflets and thus affect the function of the valve. The procedure for aortic valve insufficiency in aortitis includes AVR and ARR. perivalvular leakage is very likely to occur after AVR, even for valve avulsion, and the mechanical valve is found to be unhealed with more than 1/3 of the natural annulus or even the entire circumference when reoperated. perivalvular leakage is rare after ARR, and none of the 11 patients in our group who underwent aortic root replacement for the first time had perivalvular leakage after surgery. perivalvular leakage after AVR occurs The reason may be that the enlarged annulus is under greater tension when the prosthetic valve is placed, and the mechanical leaflet also exerts a certain tension on the natural annulus when opening and closing, which, together with the fragility of the inflammatory annulus, makes it difficult for the prosthetic valve to heal with the natural annulus, resulting in perivalvular leakage or even valve avulsion. The ARR removes the diseased aortic sinus and part of the ascending aorta, and the tension generated by the mechanical valve leaflets during opening and closing is distributed over the prosthetic vessel, which reduces the tension on the natural annulus and reduces the chance of perivalvular leakage after surgery. The modified Cabrol’s procedure not only reduces the tension on the coronary anastomosis and decreases the chance of pseudoaneurysm, but also allows simultaneous widening of the coronary opening, potentially avoiding coronary artery bypass surgery and simplifying the operation. The modified David’s procedure also preserves the autologous aortic valve, avoids anticoagulation complications, and improves the patient’s quality of life.