Aortic valve replacement is one of the most significant advances in medical treatment of cardiovascular disease in this century. It has allowed the replacement or severely stepotic or regurgitant aortic valves leading to relief of severe chronic and acute symptoms and salvage of patients with limited life expectancy. The evolution of aortic valve replacement devices has taken place over about a 30-yr period beginning with the first successful mechanical valve, the Starr-Edwards bail and cage valve. This review summarizes the biologic and mechanical FDA-approved devices currently in use in the United States, and summarizes morbid events alter aortic valve replacement, including structural valve degeneration, thromboembolism perivalvufat leak and infectious valve degeneration. The choice of the appropriate aortic valve prostheses depends on socioeconomic factors, clinical indications, and pahthoanatomic findings at the time of surgery. The availability of many excellent hemodynamic and durable devices allows matching the best valve to the patient in need of aortic valve replacement.