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Background Studies performed to date reporting outcomes after mechanical or bioprosthetic aortic valve replacement (AVR) have largely neglected the young female population. This study compares long-term outcomes in female patients aged < 50 years undergoing AVR with either a mechanical or bioprosthetic valve. Methods In this propensity-matched study, we compared outcomes after mechanical AVR (n = 57) and bioprosthetic AVR (n = 57) between 2004 and 2018. The primary outcome of this study is survival. Secondary outcomes include the rate of reoperation, stroke, myocardial infarction, rehospitalization for heart failure, and incidence of serious adverse events. Outcomes were measured over 15 years, with a median follow-up of 7.8 years. Results In patients receiving a mechanical AVR vs a bioprosthetic AVR, overall survival at median follow-up was equivalent, at 93%. There is a lower rate of reoperation in patients receiving a mechanical AVR vs a bioprosthetic AVR (1.8% vs 8.8%). The rate of new-onset atrial fibrillation was significantly higher in the mechanical AVR group vs the bioprosthetic AVR group (18.2% vs 7.3%). No significant difference was seen in the rate of serious adverse events. Conclusions These results provide contemporary data demonstrating equivalent long-term survival between mechanical and bioprosthetic AVR, with higher rates of new atrial fibrillation after mechanical AVR, and higher rates of reoperation after bioprosthetic AVR. These results suggest that either valve type is safe, and that preoperative assessment and counselling, as well as the follow-up, medical treatment and indications for intervention, must be a collaborative decision-making process between the clinician and the patient.