One hundred and forty consecutive patients from 12 to 74 years old (mean 52) who underwent isolated elective aortic valve replacement with antibiotic-sterilized homografts have been followed for 10 to 13 (mean 11) years. There were four (2.9%) early and 48 (34.3%) late deaths. The overall survival rate was 81% at 5 years and 65% at 10 years. Valve failure occurred in 37 (26.4%) patients and was due to degeneration in 27 (19.3%), technical failure in three (2.1%), and endocarditis in seven (5%). Freedom from valve failure was 90% at 5 years and 72% at 10 years; the mean rate of valve degeneration was 1% per year up to 5 years, 2% from 5 to 8 years, and 5% from 8 to 10 years. Functional evaluation of the patients retaining their original homograft at 10 years showed excellent or good results in 82% and fair or poor results in 18%. A multivariate regression analysis of factors influencing survival and valve failure showed that older age of the patient (p less than .01) and the development of postoperative left bundle branch block (p less than .05) adversely affected survival, and that older age and sex (female) of the patient (p less than .01), the type of original valve lesion (stenosis) (p less than .05), and the interval between death and dissection of the grafts (p less than .01) were good predictors of valve failure.