Reliable aortic valve replacement was one of the most significant advances in the treatment of cardiac disease in this century. It allowed, for the first time, a reliable and reproducible method to palliate the symptoms of aortic stenosis and regurgitation and significantly improved longterm survival over that after medical treatment. Sporadic attempts at aortic valve replacement had been conducted in the late 1950s, but the pioneering work of Harken et al, followed by the final development of a reliable device by Starr, Edwards, and coworkers, opened the era of successful aortic valve replacement. We review the prognosis of patients following aortic valve replacement with aortic stenosis and regurgitation with and without associated procedures and evaluate the various types of bioprosthetic and prosthetic valves in current use, presenting advantages and disadvantages of each type of replacement device.