Cryopreserved homografts were used for mitral valve replacement in selected cases, in whom valve repair would not have been successful. These were used in 10 patients (four males, six females; mean age 47 ± 8 years), either for complete (n = 7) or partial (n = 3) mitral valve replacement. Preoperative transesophageal echocardiography (TEE) measurements for valvular and ventricular dimensions were compared with intraoperative values for choosing correct homograft size. Follow up included clinical examination, electrocardiography and echocardiography. Intraoperative TEE revealed a mild insufficiency (grade 1) in six patients and no insufficiency in four. The papillary muscle-mitral annulus distance was the most reliable preoperative parameter for determining the required homograft. At one-year follow up, four patients had competent grafts, while six presented with grade I insufficiency. There were no signs of an endocarditis during the follow up period. In conclusion, mitral homografts for valve replacement or repair are recommended in selected cases in whom conservative reconstruction techniques are not possible.