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Background and Aims of the Study: Ninety-one of 351 patients who received an aortic valve replacement (AVR) with the St. Jude Medical (SJM) valve at the Royal Melbourne Hospital between 1978 and 1990 were 50-year-old or younger. The results of these patients were retrospectively analyzed so that comparison may be made with the long term results of homograft AVR., Material and Methods: There were 75 males and 16 females. Mean age was 39 years (range 15-50 years). Valve pathologies were, congenital (32), degenerative (30), rheumatic (20), infective endocarditis (7). All patients had warfarin post-operatively., Results: Follow up was complete with a total of 689 patients years, (range 34 months to 14.75 years, mean 7.6 years). There were two operative deaths (2.2%) and three late deaths (0.5 +/- 0.3%/patient-year) and two have undergone subsequent cardiac transplantation. Seventy-eight of 86 survivors (91%) are in NYHA functional Class I. At 10 years, actuarial survival was 94 +/- 2.9%, freedom from embolism was 96.4 +/- 2.4%, and from anticoagulant (AC) hemorrhage 89.4 +/- 6.5%. There were no structural failures; four cases paravalvular leaks were reported. Freedom from non-structural deterioration at 10 years was 95.3 +/- 2.3%. Freedom from reoperation was 95.6 +/- 3.2% at 10 years. Linearized rates (% per patient-year) were for embolism 0.6 +/- 0.5, AC hemorrhage 0.8 +/- 0.2, non-structural dysfunction 0.8 +/- 0.2 for endocarditis 0.4 +/- 0.5, and for reoperation 0.4 +/- 0.4., Conclusions: The SJM valve prosthesis has performed well in the aortic position in this younger group of patients up to 10 years.