From June 1986 to December 1996, 69 patients older than 70 years old underwent AVR (29 cases), MVR (21 cases), MVP (5 cases), DVR (10 cases), aortic root replacement (3 cases), repair of PVL (1 case) in our hospital. There are five (7.2%) operative and hospital deaths. The survival rate was 88.4% at 10 year after surgery and three (4.7%) late deaths. The factors associated with early deaths were renal dysfunction and DVR. Our surgical results suggest that open heart surgery can be performed safely even elderly patients, in spite of their precarious physiologic homeostasis. Not the chronological age but the physiological age is important determinant for surgical indication. If quality of life (QOL) can be expected to be enhanced, we recommend an aggressive surgical approach.