Aim — to analyze the outcomes of aortic valve replacement with small prostheses (≤ 21 mm) in young patients. Material and methods. Isolated aortic valve replacement has been performed in 89 patients aged younger than 60 years for the period 2007—2017. Mean age and body surface area were 48.1±11.3 years (from 6 to 59 years) and 1.8 m2 (1.3 to 2.2 m2), respectively. The following prostheses were implanted: Carbonics-20 (n=8), MICS-21 (n=1), Tricardics-21 (n=1), St. Jude Medical-21 (n=1), Medtronic Hall-21 (n=1), ATS-18 AP (n=12), ATS-20 AP (n=26), Carbomedics-19 (n=4), Carbomedics-21 (n=24), On-X Valves-19 (n=2), On-X Valves-21 (n=9). Four patients underwent aortic root enlargement by Nicks. Results. There was no in-hospital mortality. In long-term follow-up (mean 5.9 years, 9 months — 11 years) 3 (4%) patients died. Peak and mean pressure gradients on standard prostheses (Carbonics, MICS, Carbomedics, Medtronic Hall, Tricardics) were 27.6±8.3 (14—51) and 14.9±4.3 mm Hg (8.8—25), respectively. In case of modern models with increased effective orifice area (ATS 18 AP, ATS 20 AP, On-X Valves) the same values were 24.1±9 (11—35) and 12.4±5.1 mm Hg (7.1—20) (p<0.05). Prosthesis-patient mismatch (PPM) was observed in 11 (15%) patients and 2 of them had severe mismatch (indexed effective orifice area ≤0.65 cm2/m2) after Carbonics-20 and Carbomedics-21 valves deployment. Modern models (ATS-18 AP, ATS-20 AP, On-X Valves) were not associated with severe PPM. Conclusion. Modern artificial valves with increased effective orifice area provide good results of aortic valve replacement in patients younger 60 years.