Background: Aortic valve disease is a major cause of cardiovascular morbidity and mortality globally. Surgical aortic valve replacement has traditionally been the definitive treatment for advanced aortic stenosis and regurgitation. Anticoagulation, prosthesis durability, and poor hemodynamics have created interest in the use of other techniques. The Ozaki procedure, an aortic valve reconstruction with autologous pericardium, has become an acceptable surgical choice in several etiologies, such as rheumatic disease, bicuspid valves, and calcific degeneration. Perioperative transesophageal echocardiography (TOE) is essential in the assessment and management of this new procedure. Methods: We retrospectively studied 17 patients who had the Ozaki procedure from January to December 2024 at a tertiary care center. Information was gathered from clinical records, operating reports, and perioperative echocardiographic data. All operations were by the same surgical team, and intraoperative TOE evaluation was uniform before and after cardiopulmonary bypass. Results: Seventeen patients (14 men, 3 women) were admitted with aortic diseases, of whom 8 had aortic stenosis and 9 aortic regurgitation. Mean preoperative valve area was 2.08 ± 0.84 cm^2 with a mean gradient of 20 ± 21 mmHg. Trivial aortic regurgitation after surgery was present in 3 patients. Mean gradient was profoundly reduced to 6 ± 5 mmHg (p=0.004). Three patients needed reoperation for moderate or severe regurgitation on postoperative day one. No other significant complications were observed. Conclusion: Our experience indicates that the Ozaki procedure can provide satisfactory early hemodynamic results and eliminates the need for long-term anticoagulation. Intraoperative TOE provides invaluable information in assessing cusp geometry, validating valve competence, and determining the necessity for urgent revision. Multicenter studies with larger numbers of patients are needed to confirm long-term durability and optimize patient selection criteria for this novel approach.