Bileaflet mechanical valves are a valuable option for patients undergoing valve replacement surgery. All of the bileaflet designs provide good hemodynamic performance with long-term durability. However, some designs may provide better hemodynamic profiles in smaller valve sizes. Furthermore, newer models may have a more favorable thromboembolic profile. Nonetheless, the risk of anticoagulant-related complications with mechanical valves must be weighed against the risks of structural deterioration and reoperation of bioprostheses. Ultimately, the choice of prosthesis should be made after careful discussion with the patient, referring cardiologist, and cardiac surgeon.