Between 1990 and 1997, 64 homografts were implanted in 62 adults with non-endocarditic valve lesions. In total, 23 pulmonary grafts (PG) and 41 aortic grafts (AG) were used. Three patients (two AG, one PG) died from early postoperative complications. Three PG had to be explanted due to primary malfunction, and five during further follow up due to severe aortic insufficiency (mean 3.3 ± 1.8 years). In contrast, all AG were functioning at the end of the observation period. The degree of regurgitation for PG was significantly higher than for AG (2.2 ± 1 vs. 0.75 ± 0.7, p <0.0001); the peak transvalvular gradient was similar in both groups (PG 12.3 ± 9 vs. AG 16.7 ± 10 mmHg). Perioperatively, patients with PG showed a significantly higher body temperature during the first seven postoperative days (37.3 ± 0.6 vs. 36.8 ± 0.3° C, p = 0.003). Three patients with acute graft malfunction in long-term follow up had a perioperative febrile response without overt bacterial infection. In contrast to aortic grafts, pulmonary homografts should not be used for aortic valve replacement because of their high rate of malfunction, both acutely and chronically. Higher postoperative body temperatures may lead to further investigations of possible immunoreactions against pulmonary homografts.