Although significant progress has been achieved in heart surgery since the first successful valve replacement performed in the year 1960, some problems regarding mechanical and bioprosthetic valves still persist. Towards 2000s, pulmonary autografts came to the fore again for mitral valve replacement. These results have been promising for the long-term. However, early-period complications are frequently observed in these operations that are technically challenging and require considerable experience. For these reasons, pulmonary autografts are not applicable for extensive usage; instead they are a good alternative to be used in selected cases (patients in whom use of warfarin is not practical and extended durability of valve is desired).