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Summary: Increasing life expectancy coupled to an increasing incidence of cardiovascular disease with age is leading to an ever increasing number of elderly referred for aortic valve replacement. Patients. —: Hospital mortality has been analysed and updated according to a group of 442 patients aged ⩾80 years who underwent an aortic valve replacement between January 2000 and December 2004 either isolated (n = 344) or associated with coronary revascularisation (n = 86), mitral valvuloplasty (n = 5) or aortic surgery (n = 7). A group of 621 octogenarians operated before December 2000 was analysed in order to determine long term results. Results. —: Operative mortality is 7.5% (n = 33). Independent predictive factors of mortality were : aortic insufficiency (30%, p < 0.004), NYHA class IV (20.5%, p < 0.001), left and right heart failure (11.5 % and 19.4%, p < 0.02), chronic renal insufficiency (18.5%, p < 0.04), emergency (37.5%, p < 0.001, OR = 4.7) left ventricular ejection fraction (21.1 %, p < 0.004, OR = 0.9) and redo surgery (35.3%, p < 0.001, OR = 6). Mortality was also increased in case of coronary revascularization (11.6%), mitral or tricuspid surgery (20%) and ascending aorta procedure (25%). Conclusion. —: Functionnal improvement and increasing long term survival obtained at the cost of a rather low operative mortality, justify aortic valve replacement in octogenarians. Surgical decision should be taken on an individual basis taking into account general status and mental heath. [Copyright &y& Elsevier]