Aim. This study aimed to analyse the early results of aortic valve replacement in patients with severe left ventricular dysfunction: i.e. a left ventricle ejection fraction (LVEF) ≤30%.Methods. This retrospective study included 145 adult patients with isolated aortic valve disease and LVEF ≤30% who underwent aortic valve replacement from 2005 to 2019 at our institution. Patients who required any concomitant or redo surgery were excluded from the study.Results. There were three perioperative deaths (in-hospital mortality, 2.1%) due to multiple organ failure syndrome (two patients) or acute heart failure (one patient). Postoperative heart failure was the prevailing non-lethal complication (73% of cases). Other complications occurred less frequently: nine patients (6.2%) had acute kidney injury (four of whom required hemodiafiltration), one patient (0.7%) suffered a stroke, six patients (4%) required chest re-exploration for bleeding and two patients (1.4%) experienced sternal infection of the surgical wound. Patient LVEF improved significantly from 22.6% ± 5.3% to 35.8% ± 11.0% postoperatively (a 37% mean increase; p = 0.02), and most patients (73%) were classified as New York Heart Association class I–II by the time of discharge.Conclusion. Our study showed excellent results of surgery for aortic valve disease in patients with severe left ventricular dysfunction. Postoperatively, there was a marked increase in LVEF and significant clinical improvement. Received 1 May 2020. Revised 12 May 2020. Accepted 18 May 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: S.S. Babeshko, K.O. Barbukhatti, V.A. PorkhanovData collection and analysis: S.S. Babeshko, D.I. ShumkovDrafting the article: S.S. Babeshko, Y.P. SamurganovStatistical analysis: S.S. Babeshko, D.I. ShumkovCritical revision of the article: S.S. Babeshko, Y.P. Samurganov, K.O. BarbukhattiFinal approval of the version to be published: S.S. Babeshko, Y.P. Samurganov, D.I. Shumkov, K.O. Barbukhatti, V.A. Porkhanov