The long-term outcomes of 292 patients having stented xenograft aortic valve replacement (AVR) (group 1) and 376 having stentless AVR (group 2) were compared. Patients in group 1 were older (75 ± 9 years v 70 ± 6 years, P = .01), had more advanced cardiac disease (New York Heart Association [NYHA] classification III-IV: 85% v 75%, P = .03), and more associated procedures (53% v 41%, P = .01). Early mortality was higher in Group 1 (6.2% v 2.6%, P = .02), primarily due to cardiac cause (5.4% v 1.5%, P = .009). During follow-up (37 ± 30 months v 43 ± 35 months, P = not significant [ns]), 66 late deaths were recorded (12% v 9%, P = ns). At 8 years, survival (70% ± 5% v 81% ± 3%, P = .01) freedom from cardiac death (85% ± 1% v 92% ± 3%, P = .02) and prosthesis-related death (79% ± 5% v 95% ± 2%, P = .004) was higher in Group 2, but freedom from structural deterioration was similar (92% ± 5% v 93% ± 3%, P = ns). Late functional status was equally satisfactory (NYHA classification I-II: 89% v 90%, P = ns). Stentless AVR may confer selective survival advantages. Because freedom from valve failure is similar to stented xenografts, extension of stentless AVR to patients without anatomic contraindications appears justified.