The surgical relief of complex multilevel left ventricular outflow tract obstruction remains a challenging surgical problem. We present a new operation which combines the concepts of aortoventriculoplasty, extended aortic root replacement and the use of a pulmonary autograft. Four patients underwent this operation without mortality and morbidity. All patients were in sinus rhythm and showed excellent function of the autograft valve at early follow-up. This operation might present a more durable or even a definitive solution in the management of complex left ventricular outflow tract obstructions.