Modern tilting disc and bileaflet prostheses, and bio-prostheses, perform similarly regarding pressure gradients, discharge coefficient and performance index; however, only bio-prostheses increase their opening area with increasing flow. Ball valve prostheses of the Starr-Edwards type perform less satisfactorily with higher pressure gradients and lower performance indices, which may result in less favorable long-term follow-up. Bio-prostheses show degenerative changes with increasing age which, over a period of 7-10 years, can lead to clinically relevant stenoses necessitating reoperation.