The long-term results of primary aortic surgery on Marfan patients are presented, and the morbidity and the functional status of the long-term survivors are discussed. Between 1977 and 1998, 74 Marfan patients underwent first-time aortic surgery. In total, 45 patients (61%) underwent emergency operations; 30-day mortality was 12%. Emergency operations and surgery extended to the arch were risk factors for 30-day mortality. Overall actuarial survival was 63.4 ± 8% at 10 years. Age was the only risk factor for late mortality. Seventeen patients have been reoperated during the follow up period. Freedom from early and late mortality, reoperation on the aorta and major cardiovascular events was 33.3 ± 8.1% at 10 years. Some 98% of patients were in NYHA functional class I or II, and 80% were working. Close follow up of Marfan patients is important. Functional status of surviving patients is satisfactory.