© 2015 The Society of Thoracic Surgeons. It remains unclear as to whether mechanical valves have a role in pulmonary valve replacement. A systematic review and meta-analysis was performed to answer this question. Nineteen observational studies, including 299 pediatric and adult patients with a mean follow-up of 73 months, were analyzed. Nonstructural valve deterioration and valve thrombosis occurred in 1.5% and 2.2% of patients, respectively. Surgical reintervention was required in 0.9% of cases and thrombolysis was required in 0.5%. Mechanical valves in the pulmonary position are associated with a low incidence of valve deterioration and thrombosis, as well as freedom from reoperation and thrombolysis.