Background and aim <p>to document the Egyptian experience with Ozaki procedure in adults and children and compare the clinical outcomes of the procedure to that of aortic valve replacement (AVRc) in adult patients.</p> Patients and methods <p>The study included adult and pediatric patients submitted to the Ozaki procedure with available 1-year follow up data. In addition, adult patients submitted to AVRc during the study period were also included for comparison. Recorded outcome parameters included intensive care unit stay, hospital stay and early and late postoperative complications and mortality.</p> Results <p>The present prospective study included 72 adult and 25 pediatric patients with aortic valve disease (AVD). Adult patients were submitted to Ozaki procedure (<i>n</i> = 31) or AVRc (<i>n</i> = 41) while all pediatric patients were submitted to Ozaki procedure. One year follow up demonstrated that patients submitted to the Ozaki procedure had significantly higher peak pressure gradient (28.6 ± 7.6 versus 21.0 ± 5.7 mmHg, <i>p</i> &lt; 0.001) and higher mean pressure gradient (13.5 ± 4.4 versus 10.5 ± 3.2 mmHg, <i>p</i> = 0.002) when compared to patients in the AVRc group. In the Ozaki group, moderate aortic stenosis (AS) was identified in only 1 patient. In the pediatric group, at one year follow up, there were 8 patients (32.0%) with trivial aortic regurgitation (AR), 12 patients (48.0%) with mild AR and 4 patients (16.0%) with moderate AS.</p> Conclusions <p>Ozaki procedure appears to be a promising alternative to AVRc in adults and children with AVD with good efficacy and safety profile.</p>