Experience with 261 subjects undergoing aortic valve replacement is presented. The mean age of our patients (29.6 years) is much less an compared to reports from the West. History of rheumatic fever was obtained in 53%. Aortic regurgitation was documented in 72.7% of our subjects whilst the remainder had calcific aortic stenosis. The left ventricular and diastolic pressure was elevated in 24% and the systemic index was less than 3 l/min/m2 in 71%. Associated mitral stenosis was present in 31 subjects (11.8%) who had concomitant open mitral valvotomy. The Starr-Edwards ball valve model 1260 was utilised in the great majority (76.6%). The overall hospital mortality was 9.9% which had decreased to 4.5% during the last five year period. Poor myocardial protection leading to low cardiac output occurring in class IV subjects was the cause of death in most instances. All survivors were followed up for periods ranging from 1 to 12 years (mean 4.2). Thrombo-embolic phenomenon occurred in 1.6 per 100 patient years and the incidence of paravalvar leak has been extremely low (0.4%). This is in striking contrast with reports from other authors. Actuarial analysis at the end of 5 years and 10 years indicates overall probability of survival of 92.9% and 92.2% respectively.