Yesterday we operated on a patient, female, 56 years old, with diastolic aortic valve malformation with severe stenosis and incomplete closure, widened ascending aorta, 4.8 cm in diameter, 4.2 cm in diameter in the aortic arch, normal cardiac function, LVEF 55%, LVDD 5.4 cm, LAD 4.0 cm, no abnormalities on coronary angiography, ECG showed sinus rhythm. The patient was in good physical condition and had class 1 cardiac function. The patient’s family was interested in choosing a mechanical valve before surgery because the patient was still young and was concerned that a second operation would be required for a bioprosthetic valve. I gave the suggestion of a biologic valve because the patient had normal cardiac function, no atrial fibrillation, and could live like a normal person after a short-term anticoagulation (3-6 months) with a biologic valve, without the need for anticoagulation and other treatments, avoiding anticoagulation complications. A second surgery was performed when the bioprosthetic valve failed, and it is likely that a transfemoral catheter implantation of the aortic valve would have been an option by then. Therefore, on the second day of surgery, a larger valve, the 25-gauge bioprosthetic valve, was selected, and aortic root replacement (Bentall’s procedure) was chosen considering the patient’s bivalved malformation and the widening of both the aortic sinus and ascending aorta, while a subtotal arch resection prosthetic vessel replacement was performed under reverse perfusion of the superior vena cava in a deep hypothermic stop circulation, with a stop circulation time of 10 minutes. The tracheal intubation was removed and recovery is now well underway. A patient operated today is a 51-year-old female with severe aortic valve insufficiency, severe mitral valve insufficiency, severe tricuspid valve insufficiency, LVEF 45%, LVDD 7.6 cm, LAD 6.6 cm, and severe pulmonary hypertension. The coronary angiogram was normal and the electrocardiogram showed atrial fibrillation rhythm. Cardiac function was grade 3, and there was bilateral lower limb edema. The patient’s daughter was a student of pharmacology at the University of Traditional Chinese Medicine, and she preferred a bioprosthetic valve in the preoperative conversation. I advised a mechanical valve because the patient was still young and had a good chance of reoperation, and the chance of success of radiofrequency ablation in this patient with atrial fibrillation was less than 50%, and if postoperative ablation of atrial fibrillation was not successful, warfarin anticoagulation would be needed to prevent left atrial thrombosis even with the replacement of the biologic valve. However, the patient’s daughter insisted on a bioprosthetic valve because she was afraid of the complications caused by warfarin anticoagulation. In today’s surgery, the mitral valve was replaced with a 29-gauge bioprosthetic valve, the aortic valve with a 23-gauge bioprosthetic valve, the tricuspid valve with an artificial annulus, and atrial fibrillation with radiofrequency ablation. The operation skin to skin was 3 hours and 15 minutes and we expect the postoperative AF ablation to be successful.