Background: The ultimate goal of mitral valve surgery in younger women is to extend life expectancy and improve quality of life. Mitral valve replacement prosthesis in the middle-aged women is a difficult choice between the lifelong anticoagulation of a mechanical prosthesis versus a limited long-term durability of the bioprosthesis. The current trend towards reducing the women age for selection of the mitral bioprosthesis over a mechanical prosthesis lead to a dilemma for younger women decision making.1,2 The aim of this study is to compare the clinical out-comes after mitral valve bioprosthesis versus mechanical prosthesis in younger women population when mitral valves repair not feasible or unsuitable. Methods: A single-centre prospective non randomized registration of all women patients undergoing Mitral Valve Replacement at our center from January 2010 to February 2020 established. Results: Between January 2010 and February 2020, 355 female patients underwent mitral valve replacement at our center, 174 female patients of them had mitral valve replacement with mitral bioprosthesis (Mb) and 181 female patients of them had mitral valve replacement with mitral mechanical (Mm) prosthesis. Our study proved that the use of anticoagulation among the Mm young women associated with a remarkable risk of postoperative bleeding, abortion and increase frequency of the pregnancy related complication of the anticoagulation (p=< 0.0001), moreover, there is a considerable survival benefits for younger women patients received Mb(p= 0.0001). Conclusions: These data confirm that the impulse for the use of mitral bioprosthesis for young women population has been great with an astonishing survival benefits.