During a five-year period from 1996 to 2000, the Medtronic Freestyle stentless bioprosthesis was implanted in 310 patients of advanced age. Age at operation ranged from 60 to 90 years (mean, 76 +/- 4 years). 191 patients were female and 119 male. All implants were done by the modified subcoronary method using our own modification which enabled an improved adaptation of the porcine aortic root to the human anatomy. Two sinuses were scalloped and the third left intact. Additional coronary bypass grafts were necessary in 129 (39%) patients and mitral valve procedures in 23 (7%). Mean perfusion time was 109 +/- 12 minutes and crossclamp time 87 +/- 8 minutes. 16 (5%) patients died perioperatively. Another 17 (5.7%) patients died during a 1 to 5.6 year follow-up (mean, 2.9 years). There was only one valve related death due to infection of the valve. In spite of the advanced age, 95% of the survivors were free from cardiac symptoms and continued to live an active and fruitful life. The biological nature of the valve and the low gradients are perhaps reasons for the good results. The long-term results are expected to be good.