Can a surgeon build a new aortic valve from a patient's own tissue—and make it last? The Ozaki procedure has attracted passionate advocates and sceptics in equal measure, emerging as one of the most debated innovations in aortic valve surgery. In this episode, Dr. Pedro del Nido and Dr. Markus Krane discuss the technique's origins, technical challenges, durability, and role in both congenital and adult practice, exploring whether Ozaki represents a niche solution or a genuine advance in the lifelong management of aortic valve disease.