Long-term experience with stentless xenograft aortic valve replacement in 376 elderly patients is presented. The results demonstrate a very low operative mortality, and satisfactory late survival. Freedom from cardiac death and from structural valve failure are in excess of 90% seven years after implantation. Reoperation, when required, can be performed at low surgical risk. Stentless aortic xenografts represent an excellent substitute for the native aortic valve in the elderly.