Objective To investigate the etiology of aortic valve diseases and their shifts, as well as the in-hospital mortality of the adults undergoing aortic valve replacement. Methods We carried out a retrospective statistical analysis on a total of 927 patients, who were identified as adults having aortic valve replacement in Changhai hospital, during the 20-year study period. Results In the past few years, the major cause of the aortic valve disease included congenital disease and degenerative condition . There was a decrease in the proportion of patients with rheumatic or infectious etiology, while an increase in degenerative or congenital etiology. During the last decade, duration of postoperative ventilation, time in the intensive care unit (ICU) and length of postoperative hospital stay reduced significantly compare with those of the first decade (P <0.05). The overall in-hospital mortality was 4.7% (44 of 927 patients). No gender difference was found in operative mortality. The in-hospital mortality have greatly decreased in the past 15 years,lower than that of the first 5 years (P<0.05)。Conclusions There was a shift in the causes of aortic valve disease. With improved cardiopulmonary bypass and surgical techniques , as well as better intensive care treatment , the in-hospital mortality of aortic valve replacement in adults decreased to a lower level than before.