Between May 1964 and November 1986, 70 patients underwent aortic valve replacement with (20%) or without (80%) additional surgical procedures. Most of the prosthetic devices were Starr-Edwards models and Björk-Shiley and Sorin tilting disks. Long-term follow-up (305 patient years) was assessed in 65 patients who survived the operation. Actuarial survival was 85 +/- 2% at 5 years and 72 +/- 6% at 20 years. The linearized rate of deaths occurring greater than 30 days postoperatively was 3.6% per patient year; sudden death was the most frequent cause of death. Preoperative functional capacity class significantly influenced the immediate outcome of surgery. Although the incidence of prosthetic valve-related complications was higher than in previous studies, survival rates were comparable.