Homografts may provide unique technical advantages in the setting of aortic root destruction from prosthetic valve endocarditis. Viable cryopreserved homografts are relatively resistant to infection, do not require anticoagulation, and exhibit satisfactory long-term durability. In a group of 33 patients undergoing homograft replacement for active prosthetic valve endocarditis, left aortoventricular discontinuity was present in 11 patients, periannular abscesses were found in 21 patients, 15 patients had vegetations covering most of the prosthesis, and severe valve dehiscence was present in 10 patients. The homograft proved versatile in allowing various techniques for aortic root reconstruction. All patients survived operation. Two late hospital deaths accounted for a hospital mortality rate of 6%. Of 31 hospital survivors, 26 (83%) remained free of major events at a mean of 20.1 months. Overall late survival including all deaths was 73.1% +/- 11.98%. All but one patient is FC 1. In addition to the technical advantages offered by the homograft, the relatively low morbidity and mortality incidence associated with its use in prosthetic valve endocarditis makes it an appealing alternative in this setting.