From January 1986 to May 1988, 179 patients underwent percutaneous aortic balloon valvuloplasty at our institution. Forty-five (25%) patients subsequently required operation at this institution or other institutions. The indication for percutaneous aortic balloon valvuloplasty was patient preference in 15 and an estimation of excessive operative mortality in 30. Three patients required emergency operation immediately after valvuloplasty, and the other 42 had an elective operation a mean of 7.8 months afterward. All but 3 of these patients had major progression of symptoms, and all had valvular restenosis. In spite of the high-risk status of these patients, there were only four hospital deaths among the 45 patients. Three additional patients have died a mean of 11.4 months postoperatively. The condition of all survivors remains clinically improved after the valve operations. Percutaneous aortic balloon valvuloplasty must be recognized as a palliative procedure, and should be reserved for patients who are truly not candidates for operation or situations in which a brief period of reduction in gradient might improve a patient's condition before operation.