Between January 1982 and June 1989, 102 consecutive patients (25 women and 77 men) who had isolated aortic valve replacements were reviewed. The overall early operative mortality was 5%. The deaths were related mainly to pump failure and endocarditis. The early operative mortality in younger patients (less than 70 years old) was 3.5% and in the elderly (70 or older) 11%. The overall late mortality was 4%. All of the survivors except three (follow-up by telephone) were seen in follow-up by cardiologists. The mean follow-up was 40 +/- 26 months (range four to 89). Eighty-seven per cent of all patients or 92% of the survivors in the younger population did well following the operation. In the elderly patients, the results were less favorable (P less than 0.025). The overall cumulative survival was 92% at one year and 89% at five years. The actuarial event-free percentage of survivors was 86% at one year and 74% at five years. Aortic valve replacement can be accomplished in symptomatic patients with an acceptable operative mortality. Long term follow-up of these patients showed functional improvement and low mortality.