Introduction: The Ross operation provides a living aortic valve substitute with very good results in the medium term. There is continuing concern about its durability in adults. Methods: We reviewed a series of patients operated on (by a single surgeon) and prospectively followed up at our centre who underwent the Ross operation at least 15 years before. Results: Among 84 patients (69 male, median age at operation 37.5 (range 19.8 - 64.4)), there were 1 early and 4 late deaths. Actuarial survival was 94.9% (55 patients at risk (PAR)) at 15 years and 87.6% (10 PAR) at 19 years, compared to 95.6% at 15 years and 92.7% at 19 years for an age and sex matched UK population. Actuarial freedom from aortic or pulmonary reoperation was 89% (51 PAR) at 15 years and 72.1% at 19 years (10 PAR). Serial echocardiographic follow-up demonstrates stable aortic root dimensions over time without ventricular dilatation. Figure 1 shows the degree of aortic regurgitation over time, which has not increased in the large majority of patients. We assessed quality of life using the Short Form-36 point questionnaire which was 50·7 [median score, 2014, IQR 43.4-59.7] vs 51·0 [2009, IQR 45·9-56·1], non-significant). This compares favourably with previously published quality of life scores in patients with prosthetic valves. Of note, our oldest patient (a female aged 64 at operation), is now 80 years old with maintained valve and ventricular function, and leading an active life. Conclusions: It is concluded that the Ross operation provides a durable aortic valve and root substitute with good quality of life for periods of up to twenty years.