normofthenorth
Well-known member
Gatorsurfer, I think you've got a bunch of good advice already. The timing of the surgery and the choice of valve are both important decisions that you've got to make, or help make.
I view the timing as partly a tradeoff between physical and physical factors (competing ones), and partly a tradeoff between the net sum of those physical factors and the psychological factors. Basically, if you feel fine, you may as well postpone the nuisance and risks of Coumadin (assuming mechanical) or the deterioration of your new valve (assuming tissue). Furthermore, if you ARE prone to Aortic Root enlargement or aneurysms or dissection, delaying may help your surgeons make the best decision about what to replace and what to leave. (Some AR damage is done by the defective BAV, but some of it is caused by the same factors that are deteriorating the BAV.)
On the other hand, still physically, your heart is already making accommodations to your failing BAV, and more of those accommodations will be (and will LOOK) irreversible as time goes on, so they will draw additional cardiac repairs during your surgery. E.g., my prognosis went from "leave the Mitral Valve alone or possibly repair it" to "repair the MV or possibly replace it" during the last 6 months before my recent AVR surgery. I ended up with a MV repair (a Dacron ring) that has me on Coumadin for 3 months, which I wouldn't have minded skipping. (OTOH, my "pig" AV will probably last almost a year longer because I waited those 6 months.)
The psychological factors are different, but very real for most of us. Basically, you'll be very lucky to feel as good and as heart-healthy and fit as you do now, 6 months after your surgery. Even 9 months or a year may be a stretch, since you feel great now. If you feel that good going into your OHS and AVR, you may end up with a tough and depressing period of cardio rehab, slowly climbing and creeping back to the fitness and well-being-feeling level you had the day before surgery.
That's why many of us waited for symptoms before going under the knife and saw, and why most Cardiologists and Cardio Surgeons expect us to. NOT because symptoms pin-point the best tradeoff between permanent heart damage and the benefits of delay, but because OHS and the following rehab are "a tough sell" without any symptoms.
The tendency is gradually to operate sooner, pro-actively, but it comes with a psychological cost, even when recovery and rehab go smoothly.
As for valve choice, at 50 I think you're on the mechanical side of where the lines cross, and would almost surely expect one "re-do" if you went with a tissue valve, even the well-established Hancock II with the impressive durability stats demonstrated in the very recent "Gold Standard" article by Tirone David et al from Toronto General Hospital. (Link already posted, but I'll post it again if you ask.) On the other hand, there are still some reasons to go with a tissue valve, for some people. E.g., some people have serious trouble getting their INR (Coumadin) levels to stabilize, for whatever reason. Some people suggest a "trial period" on Coumadin to see if maintaining a stable INR is easy or hard or impossible for you, before committing to a mechanical valve. You seem to have some breathing room, and that may not be a crazy idea.
There's also a minor psychological factor in valve selection: If you commit to mechanical because you really, really, REALLY don't ever want to go through OHS a second time, and it turns out you need to do so ANYWAY, you may be more miserable about it than you would have been with a different choice.
In short, both of these choices have to be informed with good information, but they are also incredibly personal choices, to be made in a way that makes YOU comfortable with the decisions.
Good luck!
I view the timing as partly a tradeoff between physical and physical factors (competing ones), and partly a tradeoff between the net sum of those physical factors and the psychological factors. Basically, if you feel fine, you may as well postpone the nuisance and risks of Coumadin (assuming mechanical) or the deterioration of your new valve (assuming tissue). Furthermore, if you ARE prone to Aortic Root enlargement or aneurysms or dissection, delaying may help your surgeons make the best decision about what to replace and what to leave. (Some AR damage is done by the defective BAV, but some of it is caused by the same factors that are deteriorating the BAV.)
On the other hand, still physically, your heart is already making accommodations to your failing BAV, and more of those accommodations will be (and will LOOK) irreversible as time goes on, so they will draw additional cardiac repairs during your surgery. E.g., my prognosis went from "leave the Mitral Valve alone or possibly repair it" to "repair the MV or possibly replace it" during the last 6 months before my recent AVR surgery. I ended up with a MV repair (a Dacron ring) that has me on Coumadin for 3 months, which I wouldn't have minded skipping. (OTOH, my "pig" AV will probably last almost a year longer because I waited those 6 months.)
The psychological factors are different, but very real for most of us. Basically, you'll be very lucky to feel as good and as heart-healthy and fit as you do now, 6 months after your surgery. Even 9 months or a year may be a stretch, since you feel great now. If you feel that good going into your OHS and AVR, you may end up with a tough and depressing period of cardio rehab, slowly climbing and creeping back to the fitness and well-being-feeling level you had the day before surgery.
That's why many of us waited for symptoms before going under the knife and saw, and why most Cardiologists and Cardio Surgeons expect us to. NOT because symptoms pin-point the best tradeoff between permanent heart damage and the benefits of delay, but because OHS and the following rehab are "a tough sell" without any symptoms.
The tendency is gradually to operate sooner, pro-actively, but it comes with a psychological cost, even when recovery and rehab go smoothly.
As for valve choice, at 50 I think you're on the mechanical side of where the lines cross, and would almost surely expect one "re-do" if you went with a tissue valve, even the well-established Hancock II with the impressive durability stats demonstrated in the very recent "Gold Standard" article by Tirone David et al from Toronto General Hospital. (Link already posted, but I'll post it again if you ask.) On the other hand, there are still some reasons to go with a tissue valve, for some people. E.g., some people have serious trouble getting their INR (Coumadin) levels to stabilize, for whatever reason. Some people suggest a "trial period" on Coumadin to see if maintaining a stable INR is easy or hard or impossible for you, before committing to a mechanical valve. You seem to have some breathing room, and that may not be a crazy idea.
There's also a minor psychological factor in valve selection: If you commit to mechanical because you really, really, REALLY don't ever want to go through OHS a second time, and it turns out you need to do so ANYWAY, you may be more miserable about it than you would have been with a different choice.
In short, both of these choices have to be informed with good information, but they are also incredibly personal choices, to be made in a way that makes YOU comfortable with the decisions.
Good luck!
