French Polynesia has unique social, cultural and geographic features. The prevalence of acute rheumatic fever (ARF) of 1.2 % population justified the health authorities' classification of this endemic as "major, severe, and prioritary" in 1984. Seventy per cent of patients with ARF develop cardiac sequellae which require surgery in 25 per cent of cases. Bioprostheses were considered from 1975 as the ideal valve replacement for these young, often undisciplined patients with no facilities for haemostatic control. Reoperation for valve degeneration has been increasingly frequent since 1982 and poses an acute problem leading to this statistic study and to a reflection as to the value of continuing to use this type of valve in this population. Analysis of 178 Polynesians with one or more cardiac bioprostheses in 1988, totalling 221 valves with a mean follow-up of 55 months, shows an actuarial survival rate excluding operative mortality of 86.7 +/- 3 % at 5 years (93.8 +/- 2.5 % in patients under 25 years of age, p = 0.001). Fifty-two patients (29 %) have been reoperated with a probability of being free of reoperation at 5 years of 70.1 +/- 4.2% (85.2 +/- 3.9 % in patients over 25 years of age and 43.8 +/- 7.8 % in patients under the age of 25, p = 0.002). The authors discuss the alternative of bioprostheses in this population : mechanical valves with anti-coagulant or anti-aggregant therapy, frozen aortic homografts, mitral valvuloplasty.