Cardiac extension of the ascending aorta with dilatation or aortic root aneurysm is most commonly seen in patients with congenital connective tissue disease, who in general have aortic regurgitation due to dilatation of the aortic annulus without organic lesions of the valve itself. In the past, patients with this type of disease have been treated with the Bentall procedure. However, after the Bentall procedure, patients need to take anticoagulants for life because of the replacement of the prosthetic valve. As a result, patients face a number of postoperative anticoagulation complications, such as bleeding and thrombosis. Structural and functional dysfunction of the prosthetic valve is also often a nagging problem. This makes the patient’s long-term postoperative survival and quality of life can be compromised. Performing both aortic root replacement while preserving the patient’s own aortic valve is the key to solving these problems. Currently, such aortic root replacement with preservation of the aortic valve (also known as the David procedure) has been performed abroad. In recent years, another procedure using an artificial vessel with an aortic sinus (valsalva vessel) to replace the aortic root and preserve the patient’s own aortic valve has been performed in China and abroad. Compared with traditional straight vessels, valsalva vessels are more compatible with the physiological configuration of the human aortic root, thus ensuring the long-term structural and functional stability of the preserved aortic valve and improving the patient’s quality of life and long-term outcome. Although David’s procedure has significant advantages over conventional surgery, the ability to perform the procedure depends on the quality of the patient’s aortic valve itself. Patients with normal or near-normal aortic valve leaflet structure who only have aortic valve insufficiency due to an enlarged aortic annulus are candidates for the David procedure. When the patient’s aortic valve is severely deformed due to calcification, infection, or other pathology, aortic valve replacement is unavoidable.