Cardiac valve replacement carries a high-risk in hemodialysis patients and has been questioned for its results. The purpose of this study is to focus on the early and long-term results in our institution. We retrospectively analyzed the data from 41 hemodialysis patients who underwent valve replacement in our unit from July 1978 to March 2004. Bioprosthetic valves were used in 5 patients (12.2%). The overall operative mortality (30 days) was 17%. The in-hospital death rate was 22%. Late survival rate was 68% at 2 years, 54% at 3 years, 49% at 5 years, and 27% at 10 years for all patients. The incidence of major bleeding and stroke was 41%.