Objective To study effects of mitral valve replacement(MVR) on the old with mitral valve diseases(MVD). Methods The documents of 265 cases undergoing MVR were reviewed, who aged 60 years old or over between June 1991 and June 2003. Demographices, clinical preoperative conditions, indications to surgery, early postoperative course and long-term outcome were collected via hospital documents and outpatient follow-up. Many risk factors were analysed. Results Follow-up rate amounted to 93.7%(236/252). The mortality was 4.9% (13/265) within 30 days. Heart failure and renal failure were the main cause of death. Compared with younger patients(lt;60 years old), long-term survival rate was lower in the old, 5-year 87.52% vs 96.84%, 10-year 81.23% vs 94.87%. There were 15 late deaths(0.17% case/M), most of whom died of heart failure, cancers and lung infections. Risk factors for MVR in the old included New York Heart Association class Ⅳ, diabetes, and lung incompetence. Conclusions The patients with MVD over 60 years old tended to present high postoperatively mortality and morbidity.