Before a patient undergoes heart valve replacement surgery, the surgeon will ask the patient and family for their opinion on what type of valve to use. Patients themselves lack knowledge in this area and often do not know how to decide when they are suddenly asked. The type of valve chosen can still have an impact on the patient’s quality of survival after surgery. Ideally, the prosthetic valve should be durable, last as long as possible, and not cause the patient any other problems. However, no prosthetic valve currently available can meet this ideal requirement. Human blood, when flowing through the blood vessels and heart, is in contact with the endothelial cells of the blood vessels, and the blood does not clot. Once the blood comes into contact with almost any foreign body other than the endothelial cells of the blood vessels, the blood clotting process is activated and clots are produced. The prosthetic valve is artificial and is definitely a foreign body when implanted in the heart and will definitely activate the blood clotting process. After the clot is created, it may block the movement of the prosthetic valve leaflets, causing mechanical failure of the valve, or it may be washed away from the valve by the blood flow, follow the blood flow, and block the blood vessels in other parts of the body (medically called embolism). The solution to this problem is to take anticoagulant drugs that reduce the blood’s ability to clot. The prosthetic valves that are now officially approved for large-scale clinical use are divided by the materials they are manufactured from: mechanical valves and biological valves. The mechanical flap is manufactured from carbon materials, metals and artificial fabrics. It has several advantages. The first is sturdiness, which means that it is durable and will not be damaged by wear and tear. Working in simulation on a test stand, the mechanical flap can withstand over 100 years of wear and tear. The second is the small-diameter (19 mm and below) mechanical valve with a relatively large geometric orifice area, especially in the new generation of mechanical valves, whose application is not easily replaced in certain patients with small aortic roots. The third is the low height of the valve, which is suitable for certain special cases. Clinical data have demonstrated that the incidence of valve thrombosis is lower with bileaflet valves than with tilting disc mechanical valves. However, mechanical valves require patients to be on anticoagulation therapy for life and cannot be used in patients with contraindications to anticoagulation therapy. Anticoagulation carries a risk of fatal complications-bleeding and embolism. The rate of bleeding is higher in the Chinese Han population. In addition, patients with mechanical valve implantation have trouble with pregnancy and undergoing other procedures, and require staged heparin replacement warfarin therapy, but many local hospitals currently have no experience with the management of such conditions. Female patients may also have problems with increased menstruation. Although doctors emphasize the importance of standardized anticoagulation therapy and patients do what they are told to do, overall, a certain percentage of patients still die or become disabled due to complications of anticoagulation therapy. Another trouble is non-valvular structural prosthetic valve dysfunction, which is simply a mechanical disorder of the prosthetic valve. This is due to excessive tissue proliferation around the implanted prosthetic valve, which interferes with leaflet motion and causes abnormal leaflet opening and closing. Prosthetic mechanical valve dysfunction is one of the main reasons why valve patients undergo reoperation. Biologic valves are made from the pericardial or aortic valves of other animals with some artificial stents and fabrics. Among them, there are branch stent bioprosthetic valves and stentless bioprosthetic valves. This type of biologic valve is not biologically active, meaning that it is not metabolically dead in the body and will not renew, repair, or grow on its own. To put it in layman’s terms, the biologic flap is like a superior, fine leather product that works in a good environment inside the body. After the biologic flap has been implanted in the body for a long time (usually about six months), its surface is covered with deposited tissue such as fibrin and vascular endothelium, as if a coat of paint had been applied to it, due to the nature of the material used to manufacture it. In this way, its surface does not come into contact with the blood and avoids activating the clotting reaction of the blood. For these reasons, the advantage of the biologic flap is that it requires only six months of anticoagulation after the procedure and no continuous anticoagulation therapy thereafter. A special point to note here is that patients with persistent atrial fibrillation after bioprosthetic valve implantation must be treated with anticoagulation. The American Heart Association guidelines recommend warfarin anticoagulation for patients without valve disease who simply have persistent atrial fibrillation. This is true for simple atrial fibrillation, not to mention the fact that you have a prosthetic valve. Of course, the obvious disadvantage of a bioprosthetic valve is that it is not very durable and will break down over time, which is medically known as disfigurement. Stented bioprosthetic valve destruction occurs in the fifth year for the mitral valve, the eighth year for the aortic valve, and after the tenth year, the rate of destruction increases rapidly enough to have an impact on survival rates. The longevity of a bioprosthetic valve is related to several factors. The first is the amount of force applied to the valve. The higher the pressure and the larger the valve, the greater the total force on the valve and the sooner it will be damaged. This is why bioprosthetic valves break down sooner in the mitral position than in the aortic position. The second is the speed of the heart rate. This is well understood: when the total number of operations is constant, the more valve operations per unit time, the less total operation time. The third is the blood calcium metabolism. Either a high blood calcium metabolism or an abnormal blood calcium metabolism may accelerate calcification of the biological valve. In children, the bones are in a growth phase and the blood calcium metabolism is active, so the valve is prone to damage when the bioprosthetic valve is used in children and adolescents. In January 2012, Circulation, a leading journal in the field of cardiovascular disease, published an article comparing 1,113 patients with type II diabetes to an equal number of matched patients (who were otherwise the same or similar in age and sex) after implantation of a bioprosthetic valve for long-term The results of the follow-up. At 7 years after valve implantation, the rate of waiver of valve destruction was 73.2% in diabetic patients and 95.4% in nondiabetic patients. The probability of valve destruction is higher in diabetic patients with high insulin, fasting glucose, or glycated hemoglobin. Currently, authoritative clinical data demonstrate that pregnancy does not accelerate the destruction of biologic valves. The inherent inhomogeneity of the biomaterial is also a factor that affects valve durability and is difficult to completely avoid. In the case of the bovine pericardium, for example, differences in the quality of the pericardium between individual animals can compromise the durability of the final valve if this variation is not reduced during the selection process. The uniformity of artificial materials is much better than that of biologic materials. Biological valves can only be replaced with new ones if they break down. The risk during reoperation is also a factor that must be considered. When any one of the valves is damaged after the use of a bioprosthetic valve (not in the early postoperative period), the entire bioprosthetic valve in the heart must generally be replaced at the same time, unless there is a very clear technical reason for the surgery. The surgical risks associated with reoperative replacement of two or three prosthetic valves, whether in this country or abroad, are significant. Therefore, this factor is worth considering when a patient anticipates the need for two or three prosthetic valves, if his or her life expectancy is still long. Small-diameter stented bioprosthetic valves, which have a smaller effective flap area than newer mechanical valves of the same diameter, do not have good hemodynamic results after implantation, so only some manufacturers produce 19-mm-diameter bioprosthetic valves, and the smallest prosthetic valve diameter in most manufacturers’ products is 21 mm. The advantage of the stentless bioprosthetic valve is that the effective valve orifice area is relatively large. It has four problems: first, the surgical technique is complicated, second, it is too expensive, third, the currently commercialized stentless bioprosthetic valve can only be used in the aortic valve position, and fourth, it is difficult and risky to operate again after valve destruction. Such valves should be used mainly in elderly patients with small aortic roots. Based on the above rationale, physicians tend to advise patients to choose a bioprosthetic valve when there is an older patient (especially over 65 years of age), sinus rhythm, single valve disease, good financial situation, contraindications to anticoagulation therapy, and no combination of chronic renal failure. Bioprosthetic valves may also be considered in female patients who want to have children after surgery. Physicians are more supportive of the mechanical valve option if the patient is young, has persistent preoperative atrial fibrillation, has multiple valve lesions, and has a small aortic root. Currently, certain individuals within the field of cardiac surgery provide data related to the durability of bioprosthetic valves (particularly stented bioprostheses) that are not entirely objective. They promote the good outcomes obtained with stented bioprostheses in specific patients as expected for the general population. 1. generalize the rate of valve failure avoidance in some older patients (65+ or even 70 years of age) who undergo aortic valve replacement to the expected values for this valve at all age levels (the older the patient is when the bioprosthesis is implanted, the better the data related to valve durability). 2. use the waiver rate for patients undergoing revalve replacement for prosthetic valve failure as a proxy for the waiver rate for prosthetic valve failure (some patients do not undergo reoperation after valve failure for various reasons, so the number of patients undergoing reoperation after valve failure must be less than the number of patients undergoing valve failure). 3. provide the actual number of patients with valve failure in the article rather than the (actuarial values should be used statistically; if a patient dies from other causes before valve failure occurs, the valve does not fail, but assuming the valve is used in a younger patient, this valve may still fail, so the younger the patient and the longer the expected survival time, the greater the difference between the two values). 4. Use the short time (5 to 8 years) after clinical application The results within a short period of time (5 to 8 years) after clinical use are representative of the final durability values (when any new prosthetic valve is introduced into clinical use, data on its durability will not be available until a sufficient number of failures have occurred after a sufficient period of time (10 to 15 years) after the valve has been used in a large clinical setting, usually about 20 years). The more effective pulmonary valve replacements in adults are homograft aortic valves or Medtronic’s FreeStyle stentless bioprosthetic valve. A stented bioprosthetic valve or a bilobed mechanical valve should be selected for tricuspid position, avoiding the use of a tilting disc type mechanical valve.