9 Questions for Those with BioProsthetic (Tissue) Valves

[BionicBuddy]

On Nov 29, 2022, a poster by the username csigabigs started a thread called “Need Help Choosing! 14 Questions For Those With Mechanical Valve + Warfarin”.

I would also like to do my own survey, copying some of csigabigs' questions, for a total of 9, and directing it to those with bio prosthetic (tissue valves).

The people I’m interested in hearing from, need to be approximately 55 years of age or older when having received their bio-prosthetic AVR. (I’m not trying to be ostracizing here in any way to the younger crowd, it’s just very unlikely that those who are younger than 55 will live to 90 without another operation. I am open to be standing corrected on this point).

1. At what age did you get your bio-prosthetic valve?

2. How long have you had your bio-prosthetic valve for?

3. If your valve failed, what was the reason?

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?

5. Did you have any complications after your surgery?

6. What is your exercise tolerance like now after surgery?

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve?

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far?

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?

Thank you all so much.

 

[Paleowoman]

1. At what age did you get your bio-prosthetic valve?
60

2. How long have you had your bio-prosthetic valve for?
9 years 4 months

3. If your valve failed, what was the reason?
It hasn’t failed.

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?
No

5. Did you have any complications after your surgery?
A lot of pain due to being given pain medication which didn’t work but just gave bad side effects and slowed recovery the first few weeks.
I do have Patient Prosthesis Mismatch (the valve is too small for my body size) which gives high pressure gradient readings on echo but doesn't cause me actual problems.

6. What is your exercise tolerance like now after surgery?
Not as good as before surgery because of problems with my left sternoclavicular joint caused by the surgery which prevents me lifting heavy weights like I did before surgery, but otherwise I am fit and walk miles every day and I feel strong.

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve?
10

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far?
I would have questioned the necessity of having surgery at the point when the cardiac surgeon I saw said I should - at that point in time I was at the fittest and strongest that I have ever been, and I do believe that surgery should have been when I started having some symptoms. I think I should have asked for a second surgical opinion. The fact that I’m not as fit as prior to surgery corroborates that for me….but that’s nothing to do with my choice of valve.

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?
Live as healthily as you can to get and keep your body in good shape for the surgery. Prepare things at home for post surgery to make recovery as smooth as possible.

If I had been able to delay my surgery by a couple of years I would have been able to get the Inspiris Resilia valve which is the latest bio-prosthetic valve which, in theory, has a longer ‘life’ than the Magna Ease valve I have which is its predecessor. As it is I will doubtless have another operation before I’m 90 !

 

[BionicBuddy]

Thank you so much for all of your info and sharing.

1. At what age did you get your bio-prosthetic valve?
60

I remember chatting with you 11 years ago on this forum before you had your surgery. I can't find the threads now, but IIRC, you were taking Vitamin D and K2 for osteoporosis and you were really fit and doing weights.

3. If your valve failed, what was the reason?
It hasn’t failed.

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?
No

6. What is your exercise tolerance like now after surgery?
I am fit and walk miles every day and I feel strong.

Awesome!!!!

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far?
I would have questioned the necessity of having surgery at the point when the cardiac surgeon I saw said I should - at that point in time I was at the fittest and strongest that I have ever been, and I do believe that surgery should have been when I started having some symptoms. I think I should have asked for a second surgical opinion.

This too is a quandary for us (hubby and I). Our cardiologist has been saying for the past 2 decades we need to do this at the 11th hour, not at midnight. It's hard to know. Rhetorical question: Would you have done as well as you have done in a less fit and strong state of health going in?

Prepare things at home for post surgery to make recovery as smooth as possible.

IIRC, over a decade ago I was amazed at your strength and self-reliance in preparing for this process, but I can no longer find those posts. Maybe they were in old direct messaging/emailing communications. Myself, I'll be taking 2 - 3 months off of work to support hubby.

As it is I will doubtless have another operation before I’m 90 !

Do you know at this time if you are eligible for a TAVR (valve-in-valve) or is this something that is determined later?

Thanks again! Wishing you the very best and continued success, energy and fitness.

 

[Paleowoman]

I remember chatting with you 11 years ago on this forum before you had your surgery. I can't find the threads now, but IIRC, you were taking Vitamin D and K2 for osteoporosis and you were really fit and doing weights.

I actually started taking vitamin D and K2 after reading how beneficial they were for the heart on cardiologist Dr William Davis’s heart blog back in 2007. It was then happenstance I found they were beneficial for osteoporosis, which I have, too. In fact vitamin D and K2 seem good for health overall. I used to lift quite heavy weights, I really enjoyed that, I enjoyed the challenge!

This too is a quandary for us (hubby and I). Our cardiologist has been saying for the past 2 decades we need to do this at the 11th hour, not at midnight. It's hard to know. Rhetorical question: Would you have done as well as you have done in a less fit and strong state of health going in?

I suppose it’s impossible to say, but I think with very careful monitoring I could have realised I was having some symptoms and had surgery then. The fact that I never got back to that pre surgery level of fitness is an indication that surgery was too early - I’ve even read that on a paper about the timing of aortic valve replacement. Right now the pressure gradients across the aortic valve are in "moderate stenosis” level on echocardiogram and have been there since 3 years post op, but the pressure gradients across bio-prosthetic valves don’t mean the same thing as across a native valve. So I ask myself whether even with native valves there is an effect of the mathematical calculations on echocardiogram to some extent as heart rate seems to come into the formula. Maybe that was the case pre surgery for me ? I often wonder.

IIRC, over a decade ago I was amazed at your strength and self-reliance in preparing for this process, but I can no longer find those posts. Maybe they were in old direct messaging/emailing communications. Myself, I'll be taking 2 - 3 months off of work to support hubby.

The forum was moved so maybe older posts have got deleted ? There must be so many posts as the Valve Replacement forum has been going many years.

Do you know at this time if you are eligible for a TAVR (valve-in-valve) or is this something that is determined later?

No, I won’t be eligible for TAVR because the bio-prosthetic valve size is too small at 19mm. When they do TAVR of valve-in-valve the new valve fits inside the old one which would make my current valve which is already too small even smaller. I’ll have to have open heart surgery again.

Wishing you the very best and continued success, energy and fitness.

And to you and your hubby ! All the very best and let us know how things are going.

 

[Paleowoman]

PS - re my question about the necessity of having surgery when the cardiac surgeon said I should have it - I just remembered another thing that led me to doubt it was necessary at that point in time: in the Operation Note, which I have a copy of, the surgeon wrote that my bicuspid valve was only "moderately calcified".

Not that I could have known that in advance of surgery....perhaps I should have been offered a transoesophageal echocardiogram back then before surgery to check more on the valve ?

 

[AZATADINE]

On Nov 29, 2022, a poster by the username csigabigs started a thread called “Need Help Choosing! 14 Questions For Those With Mechanical Valve + Warfarin”.

I would also like to do my own survey, copying some of csigabigs' questions, for a total of 9, and directing it to those with bio prosthetic (tissue valves).

The people I’m interested in hearing from, need to be approximately 55 years of age or older when having received their bio-prosthetic AVR. (I’m not trying to be ostracizing here in any way to the younger crowd, it’s just very unlikely that those who are younger than 55 will live to 90 without another operation. I am open to be standing corrected on this point).

1. At what age did you get your bio-prosthetic valve?

2. How long have you had your bio-prosthetic valve for?

3. If your valve failed, what was the reason?

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?

5. Did you have any complications after your surgery?

6. What is your exercise tolerance like now after surgery?

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve?

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far?

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?

Thank you all so much.

1. 52
2. Just over 1 year.
3. N/A.
4. 75mg Aspirin daily. Warfarin for the first 3 months post op but taken off it after 3 months.
5. No complications.
6. Very good. I was asymptomatic prior to surgery and I was back to pre surgery levels after about 9 months I'd say. Horse riding nd cycling as good as ever.
7. 100%. I will need reintervention at some stage of course because of my age.
8. Not really but my recovery went very well. I'm glad I opted to have the valve changed prior to experiencing any symptoms. I could have gotten another year or so out of my native valve I'd say but opted to be proactive and get it done.
9. As other poster said, I would have perhaps been open to receiving Inspiris Resilia but my surgeon felt that there's not enough data yet and we went with Edwards Magna Ease.

One final comment is that my sleep went to hell after about 2 months....I had a couple of months of barely any sleep. Not sure why but it improved over time.

 

[skeptic49]

1. At what age did you get your bio-prosthetic valve? 66

2. How long have you had your bio-prosthetic valve for? 8 years

3. If your valve failed, what was the reason? it has not failed

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery? aspirin 325 mg daily

5. Did you have any complications after your surgery? tamponade...required a second ohs one week after the first surgery

6. What is your exercise tolerance like now after surgery? very good for my current age 74

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve? 10

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far? tried harder to get the surgery earlier

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice? just the usual stay active, eat healthy

 

[Croooser]

Kudos for supporting your/buddy/hubby. In my experience support is very, very important.

1. At what age did you get your bio-prosthetic valve? 71 yo - 27mm Inspiris Resilia. Hopefully it will last 15 - 20 years at my age. If it starts to fail, I should be a candidate for a TAVR replacement

2. How long have you had your bio-prosthetic valve for? 21 months

3. If your valve failed, what was the reason? N/A

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery? Same as prior to surgery: 81mg aspirin, 2 BP meds, atorvastatin

5. Did you have any complications after your surgery? No

6. What is your exercise tolerance like now after surgery? 3 mile walk 5 days/week at approx. 3.5 mph - with no difficulty.

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve? 10 - so far

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far? No

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?

• I greatly reduced anxiety for myself and my wife by researching and understanding valve and aneurysm issues so that I am able to read and understand test results. This really helped to understand the difference between moderate vs severe and the commensurate risks. And then to understand and make informed decisions on when to have the surgery performed, which valve to choose, what the surgical methods are - e.g. traditional sternotomy vs mini, etc. We were both still anxious but mostly confident going into the surgery.
• Research clinics and surgeons diligently. I wanted to get the very best possible skills and capabilities to give myself the best chance for a positive outcome. For me, this meant going 1000 miles from home instead of 30 miles.
• Post surgery mindset - I try to frequently remind myself that my life was extended and to make the most of it.

HTH

 

[q2bruiser]

1. At what age did you get your bio-prosthetic valve?
53 & 11 months

2. How long have you had your bio-prosthetic valve for?
6 years 8 months

3. If your valve failed, what was the reason?
N/A

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?
Metoprolol for a year
325mg aspirin every day
2000mg Vit C per doc

5. Did you have any complications after your surgery?
Had dressers syndrome about 6 weeks after surgery. Collapsed my left lung and was back in the hospital and they pulled a ton of fluid from around my lung/heart. Fine since other than PVCs that come and go.

6. What is your exercise tolerance like now after surgery?
No as good as it was, but ok

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve?
Depends upon the day. Most days 10. But some days I think about it needing replaced if I live long enough. Those days suck.

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far?
I don't know. On days I think about a possible replacement in the future I wish I had received a mechanical. But I think back and at the time the mortality rates for bleed events with Coumadin and second valve ops crossed at about 15 years. So who knows. It is my hope when I do need a replacement, the science will be at a point where I can do a last bio valve or a synthetic valve which does not need Coumadin

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?
Take care of your mental self as much or more than your physical self.

 

[tommyboy14]

On Nov 29, 2022, a poster by the username csigabigs started a thread called “Need Help Choosing! 14 Questions For Those With Mechanical Valve + Warfarin”.

I would also like to do my own survey, copying some of csigabigs' questions, for a total of 9, and directing it to those with bio prosthetic (tissue valves).

The people I’m interested in hearing from, need to be approximately 55 years of age or older when having received their bio-prosthetic AVR. (I’m not trying to be ostracizing here in any way to the younger crowd, it’s just very unlikely that those who are younger than 55 will live to 90 without another operation. I am open to be standing corrected on this point).

1. At what age did you get your bio-prosthetic valve?

33.

2. How long have you had your bio-prosthetic valve for?

Failed after 8 years.

3. If your valve failed, what was the reason?

Usually bio-valves are meant to fail gradually over a year or two. In my case, I had a stentless valve made from equine material. To the credit of the material, there was no calcification on my valve. But one of the valve leaflets tore off. This caused immediate severe regurgutation and my left ventricle started expanding very rapidly past normal - I went from moderate to severe within a week based on the Echo. Not just that but I started becoming dizzy shortly after, though it is unclear if this was due to rapid deterioation of my heart or the candesartan I was prescribed to protect my heart pre surgery.
Note: This is a very unusual way of failure.

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?

I was only on baby aspirin (75 mg).

5. Did you have any complications after your surgery?

So although I didnt feel symptomatic, my aortic root was heavily calcified and my aorta had expanded from 4.5cm 3 months pre surgery to over 5cm by the time they opened me. Myh aortic root had to be debriddled and replaced. Because of this I got PVCs and also I was told 50/50 chance of pace maker when leaving hospital. Thank god the issues sorted themselves out.

6. What is your exercise tolerance like now after surgery?

After my second surgery with a mech valve and cardiac rehab, significantly better than with the Biovalve. My mean gradient at rest is 4 with the Mech valve and was over 10 with the Bio valve the whole time. This is despite my mech valve being 25mm size vs stentless bio valve 29mm. With bio valve my BP ranged from 130-140/80 post op. With mechanical it ranges 115-120/70-80.

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve?

6, but not because of the valve failed after 8 years. Yes it was fun to go out with clients and live it up like there was nothing in my chest. With my On-X mech valve, my wife can hear and she is a light sleeper. But guess what, you may still get adverse effects with a bio valve. I had two side effects in my 8 years of bio valve: 1) After three years, I woke up and half of my face went numb. After spending all day in my local UK A&E hospital, they thought it was bells palsy, not a stroke based on the MRI, but still that never happened to me before and thankfully not since. 2) I had two significant episodes of rectal bleeding five years after which were followed by a colonoscopy. Again didnt have this since. I am not a medical professional, but this happened to me in my 30s (statistically very unlikely), so it is hard for me not see an association between my biovalve and these issues.

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far?

I had a mechanical valve for a year now. I think that this is the best solution in the under 60 group. The guidelines exist for a reason. They are based on the wisdom of the cardiac medial community as a whole. So I will say straight out that I should have listened and gone for a mechanical valve the first time around. I had a second surgery last year. Although my surgeon and the whole team were brilliant, you loose at least 3-6 month in recovery. It really isnt fun.

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?

My view is: Find the best possible medical team you can (the one with low complication rates operating/working at a top hospital) and then let them get to know you and your lifestyle. Then follow their recommendation.

Thank you all so much.

 

[BionicBuddy]

Not that I could have known that in advance of surgery....perhaps I should have been offered a transoesophageal echocardiogram back then before surgery to check more on the valve ?

Did you have a CTA? and do you think that would that have been/was helpful?

 

[Paleowoman]

Did you have a CTA? and do you think that would that have been/was helpful?

Yes I did have a CT angiogram prior to surgery. It didn't show any issues with my coronary arteries. It showed some calcification in the bicuspid aortic valve which an even previous one showed.

 

[oo0My_Valve0oo]

1. At what age did you get your bio-prosthetic valve?

62

2. How long have you had your bio-prosthetic valve for?

2 years in June of 2023

3. If your valve failed, what was the reason?

NA

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?

Warfarin / Coumadin for 3 months. Discontinued that and baby aspirin at about the same time.

5. Did you have any complications after your surgery?

For 2 weeks I was anemic from loss of blood. My blood pressure dropped dangerously low when I fell asleep so I was not getting adequate rest. The initial symptoms which lead me to the doc were not resolved by the surgery.

6. What is your exercise tolerance like now after surgery?

I cannot run. I can jog short distances. I have random onsets of fatigue, exhaustion and being out of breath. Sometimes walking across the street is a challenge. I have no reserve to draw upon. These are not resolved or prevented with extra rest. They can come on whether rested or not. Other times I feel pretty good and get by during my physically active job.

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve?

3.5 Had I known of this forum I would have had more information and gone with the mechanical. It was a challenge to arrange the first procedure. It will be much much much more of a challenge if I live to see another.

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far?

I would choose a mechanical valve. I had no advance knowledge this was coming but if it were possible to know I would focus on making and saving money for it.

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?

Don't let your decision bother you. There is nothing that can be done once you have had the procedure. Enjoy your health and life the best you can. Don't let it ruin things. And if you see the end coming do what needs to be done while you have the ability to do it.

 

[BionicBuddy]

Don't let your decision bother you. There is nothing that can be done once you have had the procedure. Enjoy your health and life the best you can. Don't let it ruin things. And if you see the end coming do what needs to be done while you have the ability to do it.

Thank you for your honest sharing. I'm sorry it didn't go as well as you would have wished it to. Living moment to moment is all we have and your perspective of intending to enjoy your life as much as you can regardless of circumstances is a stance of courage and optimism.

 

[Springdogg]

1. At what age did you get your bio-prosthetic valve?

26 and again at 34.

2. How long have you had your bio-prosthetic valve for?

7.5 years first. 6 years so far on second.

3. If your valve failed, what was the reason?

Nothing definitive...just wore out.

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?

After first I only took a baby aspirin. This time around I am also taking metoprolol in attempt to prolong the valve life.

5. Did you have any complications after your surgery?

None.

6. What is your exercise tolerance like now after surgery?

Was back to my normal self at 3 months both times. I play ice hockey (non checking) twice a week and exercise without a thought about my valve.

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve?

10 both times.

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far?

Nothing I can do. Just wish we were 15-20 years in the future as I believe we will have a prosthetic life lasting valve as an option.

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?

I was a healthy individual both times and I had a I am going to take this on mentality. I took it as a challenge to get my life back to what I had. Everyone is different, you have to find what is right for you.

 

[lilyofthewest]

1. 69
2. 6yrs
3. NA
4. At least a half dozen different drugs including Metropolol and Warfarin. I hated them all and weaned myself off everything except low dose aspirin by about month after surgery.

5. About 2 weeks after, when I went in to get the staples out I was in afib which they claimed was quite a common occurrence. Kept in the hospital overnight and they zapped my heart back into rhythm. Haven't had any problems since.

6. Since about a year out I've been back at least as much as before. Yoga or weights a couple times a week each and walking an average of almost 3 miles a day. The first 6 weeks were rough. Arthritis in my left shoulder my main complaint and probably irrelevant to heart issue.

7. 10. My surgeon recommended going this route and said TVAR would be an option if I outlive this valve. Also, I didn't want to be on warfarin. It caused an aunt to die from a bleed out at home alone after falling in her back yard and my brother had a serious almost fatal sudden bleed out. Of 6 sibs, 3 of us have had valve replacement. 1 mechanical and 2 tissue.

8. I wish I had done more research, including finding this site, and been better informed about the whole process. I may have tried to put off the surgery a bit as I didn't really have any symptoms. It was a shock when my regular dr. saw something and sent me to the cardiologist. He predicted a heart attack within 2 years if not acted on then, since the valve was seriously compromised.

9. Just to repeat what others have said and value joy and beauty each day. "Enjoy every sandwich."

 

[kentuckyed]

1. At what age did you get your bio-prosthetic valve?
64

2. How long have you had your bio-prosthetic valve for?
8 years, April 15 was my anniversary.

3. If your valve failed, what was the reason?
Hasn't failed yet.

4. Are there any medications you have had to take after surgery because of the bio-prosthetic valve replacement surgery?
Eliquis, Metoprolol both ongoing to this day.

5. Did you have any complications after your surgery?
Several slight episodes of AFIB

6. What is your exercise tolerance like now after surgery?
Marginally less than normal for a 72 year old man, but that's mainly due to my arthritis. I can still keep up with my 1 year old Havanese-Poodle mix.

7. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for bio-prosthetic valve?
10

8. Is there anything that you would do differently now, that you have had this experience, and from all the things you have learned thus far? No

9. Any further tips to share on how to experience success and a great quality of life having made this important valvular choice?
The choice was really made by my surgeon. I went along with his decision. Don't sweat the small stuff.

 

[BionicBuddy]

Here's another hopeful story. I emailed an old friend whose father I knew had SAVR long ago but I didn't know the details. Here are the details:

Received a porcine valve at age 65 in Vancouver, Canada, that has lasted almost 23 years. He is on his third pacemaker. He is 87 now and the valve is "starting to wear out". He walks with his buddy daily and cares for his wife with dementia and feels pretty good. My friend doesn't know if he is eligible for TAVR.

I'm going to peruse this forum to see what I can find out about valve-in-valve replacements.

 

[pellicle]

Received a porcine valve at age 65 in Vancouver, Canada, that has lasted almost 23 years. He is on his third pacemaker. He is 87 now and the valve is "starting to wear out".

before considering that "median" I'd examine

• how active he was after the surgery (stamp collecting or long distance running)
• diet
• overall calcium score

Averages are exactly that. Betting on you getting above average (no matter how alluring

is how casinos make money from the public

I know you know that, but I'm just saying ...

Anyway, I don't know if I've said this to you directly, but at his age its a coin toss and you'll be second guessing which cherries you'll find on the tree to pick. If its "stamp your foot and say No Way Do I Want Another Surgery" then the answer can only lean towards mechanical. If its "open to whatever the universe deals" then bioprosthesis.

Go with your gut and don't pretend you can second guess every possible curve ball the universe can throw at you (like say, glioblastoma).

 

[BionicBuddy]

how active he was after the surgery (stamp collecting or long distance running)

Very good point. Hubby and I never saw him as any "athlete" type, but looks can be deceiving. I guess like joints, the more wear and tear, the greater chance for deterioration.

Anyway, I don't know if I've said this to you directly, but at his age its a coin toss and you'll be second guessing which cherries you'll find on the tree to pick. If its "stamp your foot and say No Way Do I Want Another Surgery" then the answer can only lean towards mechanical. If its "open to whatever the universe deals" then bioprosthesis.

Go with your gut and don't pretend you can second guess every possible curve ball the universe can throw at you (like say, glioblastoma).

Very wise. Yes you've mentioned it was a coin toss to me before. I have the worst habit of analyzing every single cherry 10 times over before it's picked. Thank goodness hubby is more spontaneous and goes with what feels right for him.

And you are correct. We can't second guess every curve ball . Thank you for reminding me of this. We can only trust . . . . in whatever nourishes us . . . .