Aortic valve (AV) surgery in children presents many unique challenges, including preserving the potential for somatic growth, maximizing valve durability, and, most importantly, preserving very long anticipated life expectancy and quality of life. Current mainstream options include balloon valvuloplasties; reparative valve surgery; and valve replacement with the patient’s own living pulmonary valve, a bioprosthetic animal valve, or a mechanical valve. To this day, no single option can consistently achieve all stated goals at once. Each option carries relative limitations in terms of growth, durability, and long-term clinically relevant outcomes. Nevertheless, in choosing the appropriate surgical technique in children, it is imperative to consider 2 important notions that are tightly interwoven: 1) the normal AV is a living structure with dynamic, adaptive, and highly regulated functions (1); and 2) the key to long-term survival and quality of life is left ventricular (LV) health.