Abstract Homograft or allograft tissue has been available for use as replacement for diseased valves or reconstruction of major vessels for decades. However, with respect to replacement of diseased valvular tissue the search for the ideal valve still continues. In this review we will discuss the clinical indications, surgical techniques, and outcome of aortic homografts. Keywords Endocarditis Æ Homograft Æ Ross procedure Æ Valve repair Æ Valve replacement The ideal valve should have little or no haemo- dynamically significant gradient after implanta- tion, have no early or late morbidity, be both readily available and economical, be relatively easy to implant, applicable to any type of valve disease and be, of course, durable. Homograft tissue has excellent haemodynamics, is applicable to a wide range of valvular diseases, is flexible and conforms well to the aortic annulus of the recipient, and is remarkably resistant to infection. However, it is yet not quiet the ideal valve. Allografts and autografts have been available for more than three decades. However these are not readily widely available, are not technically simple to implant and initial preservation and preparation techniques were not good enough to provide uniform results. And so they fell largely into disuse, save for the determination of scat- tered few surgeons who persisted with this form of treatment for valvular heart disease. As a re- sult, preservation and storage techniques have come a long way and both durability and implantation methods have greatly improved the early and late outcome with the use of these valves. The emergence of companies dedicated to preserving and storing these valves for wide- spread use also provided better valves, although quite costly. The definition of homografts and allografts, autografts, and xenografts merit mention at this point. A homograft valve is a graft derived from a donor of the same species as the recipient. An allograft valve more specifically refers to both the donor and recipient being from the same species but not genetically identical. An autograft is rel- atively self explanatory, being a valve taken from one location and transplanted into another, e.g., M.L. Da Costa The Heart Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore R.M. El Oakley (&) PSHC, King Fahd Medical City, P.O. Box 59046, Riyad 11525, Kingdom of Saudi Arabia e-mail: eloakley@mac.com F. Al Ghofaili PSHC Cardiac Surgery Department, King Fahd Medical City, P.O. Box 59046, Riyadh 11525, Kingdom of Saudi Arabia Cell Tissue Banking (2006) 7:337–348 DOI 10.1007/s10561-006-9009-9 123 ADVANCES IN TISSUE BANKING Allograft tissue for use in valve replacement M.L. Da Costa Æ F. Al Ghofaili Æ R.M. El Oakley Received: 1 November 2005 / Accepted: 10 January 2006 / Published online: 5 July 2006 Ó Springer Science+Business Media B.V. 2006