The surgical treatment of the aortic valve and root disease, organic and ischemic mitral regurgitation, and endocarditis has made great strides. Still, there is the well-known dilemma: on the one hand the need for anticoagulation in patients with mechanical valves that otherwise guarantee long-term functioning and, on the other, the unpredictable durability of biological substitutes and of valve repair procedures which, per se, do not require anticoagulation. The choice of procedure is determined by factors such as patients' age, metabolic and bleeding disorders, and bleeding preconditions, as well as such critical issues as the desire to bear children in young women. The book contains a collection of proceedings of The Berlin Heart Valve Symposium which was held in November 2008. It focuses on current surgical approaches to and evolving trends in aortic valve repair, aortic root and valve replacement with pulmonary autograft, aortic allograft, stentless and stented bioprostheses. Further contributions will deal with recent advances in catheter-based percutaneous and transapical techniques, ablation techniques for atrial fibrillation, tissue engineering of heart valves, multi-modality imaging, and anticoagulation.