At our institution, we actively perform aortic valve neocuspidization (AVNeo) for aortic valve stenosis (AS) with a small annulus. In this report, we aimed to evaluate the midterm outcome of AVNeo for AS with a small annulus. From February 2011 to May 2017, we performed AVNeo for AS with a small annulus in 34 patients. Their mean age was 77.0 ± 9.1years. Preoperative transthoracic echocardiography (TTE) revealed a mean peak pressure gradient average of 84.2 ± 31.1mmHg. The effective orifice area index (EOAi) was 0.45 ± 0.14cm2/m2. The mean annulus diameter was 18.4 ± 1.1mm. Our procedure complies with the three cuspid suturing to the aortic annulus with glutaraldehyde-treated autologous pericardium. There were no conversion to aortic valve replacement and no concomitant annulus enlargement. There were two inhospital mortalities resulting from a noncardiac cause. Three patients underwent reoperation owing to aortic regurgitation (n = 2) and infective endocarditis (n = 1). One patient underwent a pacemaker implantation for complete atrioventricular block. The mean follow-up period was 28.0 ± 22.7months. Postoperative TTE showed a mean peak pressure gradient average of 18.3 ± 9.4mmHg and a calculated mean EOAi of 1.18 ± 0.35cm2/m2. The freedom from reoperation rates were 94.1% and 90.8% at 1year and 5years of follow-up, respectively. The overall survival rates were 91.2% and 76.8% at 1 and 5years of follow-up, respectively. The midterm outcome of AVNeo for AS with a small annulus was excellent. The long-term outcome and reliability of this procedure must be fully clarified.