Abstract In order to compare the results of aortic valve replacement with and without coronary perfusion, the experience with 118 consecutive patients operated upon by the same surgeon was reviewed. Seventy-five patients were operated on with coronary perfusion, and 43 patients were operated on without coronary perfusion. The overall hospital mortality was 5.3% in the coronary perfusion group and 16.3% in the group that did not have coronary perfusion. The incidence of myocardial infarction unrelated to coronary embolism was 1.3% (1 patient) in the coronary perfusion group and 14% (6 patients) in the group without perfusion. The incidence of myocardial infarction unrelated to coronary embolism was found to increase with a longer period of cardiac anoxia: 0 in the group with an average ischemia period of less than 30 minutes, 9.5% among patients with an ischemia period of 31 to 45 minutes, and 36% among patients with an ischemia period of longer than 45 minutes.