Prosthetic aortic valve endocarditis is associated with significant morbidity and mortality despite aggressive medical and surgical treatment. In most cases, surgery is the only curative treatment modality, and these operations can be extremely challenging due to often extensive perivalvular tissue destruction. The currently recommended treatment for these advanced infections is thorough debridement and aortic root replacement with a homograft, although it seems that equally good results can be achieved with composite valved conduits. Enthusiasm for the use of the pulmonary autograft as described by Ross for the treatment of noninfective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis is uncommon. We have used the Ross operation as total root replacement with success in 11 patients with native or prosthetic aortic valve endocarditis. This article describes the use of this treatment modality in five of these patients between 10 and 72 years of age with prosthetic aortic valve endocarditis. Follow-up extending to 22 months shows excellent results with no mortality and no reinfection. The pulmonary autograft seems to be technically and uniquely well suited for these cases, and it has growth potential, excellent hemodynamics, and a low risk of reinfection, thrombosis, and embolic complications, without anticoagulation.