Between 1969 and 1991, 339 patients had an aortic valve replacement withtheir own living pulmonary valve at the National Heart Hospital, Guy'sHospital and the Harley Street Clinic, London. The longest follow- up is 24years and cumulative follow-up is 3774 patient-years. No form ofanticoagulation was used and there were no emboli. There were 25 hospitaldeaths (7.4%) but only 1 death since 1976. Late deaths occurred in 38patients mainly from technical mal-insertion. Bacterial endocarditisoccurred in 11 patients. Thirty-eight patients were re- operated upon andaccount for 15 of the late deaths. Freedom from re- operation was 85% andthe actuarial patient survival was 80% at 20 years. There has been noevidence of primary tissue degeneration and explanted valves showed normalcusp cellularity. Accumulating evidence suggests that the cusps not onlysurvive permanently but can grow with the patient making the operationideal for children.