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The analysis of explanted mechanical heart valves (MHVs) is an essential sourceof information about the effects of their in vivo working. In order to betterunderstand the mechanisms arising from the interaction between MHVs andbiological environment, in this study fourteen bileaflet valves were considered.From clinical data, all the malfunctioning valves showed a high degree ofstenosis. By investigations on the MHVs components and the study of the clinicaldata, it was possible to establish that the ordinary abrasive wear does not involveclinical disease. On the contrary, impact wear and/or surface defects, due toimproper surface finishing, can generate rough areas and consequentlythrombogenic sites. The growth of fibrotic tissue can modify the cinematiccoupling with serious alteration of the leaflet motion. This work demonstrates thefeasibility of creating a database to statistically analyze the results with the aim ofimproving valves design and surgical operation.