Transfer of the pulmonary valve to the aortic position has been used successfully by Ross for more than 20 years and in our own institution since August 1986. To expand the use of this concept to patients with root disease and/or narrow annulus, we employed the main pulmonary artery with its valve as a conduit to replace the proximal ascending aorta, reimplanting the coronary ostia into the pulmonary trunk. Seventeen patients, aged 2-62 years, underwent the procedure with three deaths. Hemorrhage precipitated each death, and there was one reexploration for control of bleeding. Postoperative echocardiography showed excellent valvular function. No anticoagulants were used except daily aspirin in three patients who underwent concomitant procedures. There were no thromboembolic episodes. Right ventricular outflow tract reconstruction was accomplished with cryopreserved aortic (three) and pulmonary (14) allograft conduits. This operation has potential for superior long-term results in complex aortic valve disease.