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The long-term prognostic factors which determine the indications for surgery are studied on the basis of a series of 198 cases operated for chronic aortic incompetence, in terms of their influence on the actuarial long-term mortality rate due to heart disease and irreversible myocardial dysfunction. The mortality in the first month after surgery is 5 per cent. The factors which significantly modify the long-term outcome of operated patients are clinical (cardiomegaly, degree of preoperative heart failure, ventricular extrasystole, functional grade) and haemodynamic (mean pulmonary artery pressure, end-systolic and-end diastolic left ventricular pressures, left ventricular ejection fraction). Multifactorial studies have shown that ventricular dilatation is the most important prognostic factor. Left ventricular function is severely altered, even in patients with few or no symptoms, but, in the absence of marked functional disturbance, the prognosis is usually good, whatever the repercussions on the myocardium. Surgery should be performed routinely in patients with severe functional disturbance, in the absence of reliable individual criteria capable of predicting when the indications have been exceeded. Surgery is also legitimate in patients with few or no symptoms when investigations reveal severe effects on the left ventricular function.