The Ross procedure is a reliable and durable treatment modality for the diseased aortic valve. Geometric mismatch of the autograft and the systemic outflow tract can lead to poor results. Annuloplasty and aortoplasty were combined with the Ross procedure to correct geometric mismatch in 26 of 44 patients. Annular plication or annular fixation were used to correct a size discrepancy at the aortic annulus; aortoplasty was used to correct a size discrepancy at the sinotubular junction. There was no statistical difference in the incidence of postoperative aortic insufficiency or stenosis in patients undergoing a modified Ross procedure for geometric mismatch compared with those undergoing the basic Ross procedure. The results indicate that annuloplasty and aortoplasty are effective modifications of the Ross procedure for the correction of geometric mismatch.