UNLABELLED The search for the ideal substitute for the aortic valve led Donald Ross to develop the pulmonary autograft concept in 1967. A historical, technical, an scientific review of this surgical option is presented together with our clinical experience. MATERIALS AND METHODS The literature is reviewed to identify the advantages and pitfalls of the Ross procedure over the last decades. We also present our clinical experience with 100 patients operated between 1997 and December 2003. RESULTS Of the total, 70% (n = 70) were males, mean age was 29.32 +/- 11.9 years, with 20 patients under 16 and 6 patients under 10 years. Twenty-five patients (25%) had 31 previous interventions. There were 41 associated procedures in 34 patients. Perioperative mortality was 2% (two patients). Eight patients required reexploration for bleeding, one required an aortocoronary bypass, an one a permanent pacemaker. Follow-up was 97% with 2.71 patients/year (average 32.55 +/- 19.01 months). Two patients required Autograft replacement, one suffered a 44-mm dilatation of the Autograft, and one 13-year-old girl developed Autograft endocarditis. Six patients suffered severe Homograft stenosis (> 50 mm/Hg), two were treated percutaneously, and one required replacement. Combined freedom from reintervention is 93.56 +/- 2.81% at 5 years. CONCLUSIONS The Ross procedure is a mature concept with thousands of patients operated worldwide and a cumulative experience of over 30 years. Although we believe that it is the procedure of choice in the pediatric population, women in child-bearing age, and substantial subgroups of adult patients, efforts must continue to minimize the incidence of auto- and Homograft failure in the long-term.