The aim of this study was to reconcile some of our own previous work and the work of others to generate a physiologically realistic numerical simulation environment that allows to virtually assess the performance of BMHVs. The model incorporates: (i) a left ventricular deformable model to generate a physiological inflow to the aortic valve; (ii) a patient-specific aortic geometry (root, arch and descending aorta); (iii) physiological pressure and flow boundary conditions. We particularly studied the influence of downstream geometry, valve size and orientation on leaflet kinematics and functional indices used in clinical routine. Compared to the straight tube geometry, the patient-specific aorta leads to a significant asynchronous movement of the valve, especially during the closing of the valve. The anterior leaflet starts to close first, impacts the casing at the closed position and remains in this position. At the same time, the posterior leaflet impacts the pivoting mechanisms at the fully open position. At the end of systole, this leaflet subsequently accelerates to the closed position, impacting the casing with an angular velocity of approximately -477 rad/s. The valve size greatly influences the transvalvular pressure gradient (TPG), but does not change the overall leaflet kinematics. This is in contrast to changes in valve orientation, where changing valve orientation induces large differences in leaflet kinematics, but the TPG remains approximately the same.