A seemingly common question.......Planning head on

[JannerJohn]

I require AVR + Ascending Aorta replacement + possible root (They all said they will see once the bonnet is open). I have spoken to three surgeons and had three answers. 1. Definitely Mechanical at your age (50y) 2. Latest generation Tissue with future TAVRx2 possible or 3. What ever you want I'll fit. The fundamental question is Mechanical or Tissue. The options as best I can tell are: Mechancal: St Judes, Carbomedics or On-X. Tissue appears to be the Edwards Resilia Valve.

I know this is a very emotive and well trodden issue so I am trying to apply some logic to it.

Somewhat frustratingly I don't think this will be a question in ten years time for people as I would guess the Polymer valve technologies in the pipeline will hopefully provide lifetime durability with no Anticoagulant requirements. Several universities are even looking at 3d Stem Cell printed bio valves. I'm sure the future will be nanobots that just go in and repair your native valve ;-)

 

[dick0236]

Somewhat frustratingly I don't think this will be a question in ten years time for people as I would guess the Polymer valve technologies in the pipeline will hopefully provide lifetime durability with no Anticoagulant requirements. Several universities are even looking at 3d Stem Cell printed bio valves. I'm sure the future will be nanobots that just go in and repair your native valve ;-)

I think you SHOULD be correct in your thinking.......but I had the surgery 53 years ago and things haven't changed that much. I still take warfarin and I had no restrictions about life or lifestyle then and still don't.

"A bird in hand is worth two in the bush". I would hesitate to make a decision today based solely on what might be. If they ever come up with a foolproof fix...........problem solved........don't hold your breath

 

[Superman]

It’s like buying a car today based on what’s available with the caveat that it may be the last car you ever buy, no matter what comes out 10 or 20 years down the road. Seems odd.

But as @dick0236 says; you do what’s best for you today based on the best options you have available today and don’t look back. This isn’t really the kind of purchase where you want to be dealing with buyers remorse!

BTW - There is a best option. It’s the one that will allow you to sleep at night. I know it looks like a lot of back and forth here about mechanical vs tissue and which one and a lot of the data and reasons make sense for both sides. In the end - can I live with my choice and not worry about the road not taken? Then I’m good. You will be too.

 

[JannerJohn]

Yeah apologies ignore the future options. I guess nobody knows in twenty years by which time I would be seventy. In all reality I'm looking a the best lowest risk option to allow me to see my girls grow up some more, whilst affording me the best quality of life. Its a tough balance with the current valve technologies.

 

[Superman]

No apologies needed. It was a good question and if I may, it seemed a much healthier question than the path you were heading down. Kudos!

 

[tom in MO]

I require AVR + Ascending Aorta replacement + possible root (They all said they will see once the bonnet is open). I have spoken to three surgeons and had three answers. 1. Definitely Mechanical at your age (50y) 2. Latest generation Tissue with future TAVRx2 possible or 3. What ever you want I'll fit. The fundamental question is Mechanical or Tissue. The options as best I can tell are: Mechancal: St Judes, Carbomedics or On-X. Tissue appears to be the Edwards Resilia Valve.

I know this is a very emotive and well trodden issue so I am trying to apply some logic to it.

Somewhat frustratingly I don't think this will be a question in ten years time for people as I would guess the Polymer valve technologies in the pipeline will hopefully provide lifetime durability with no Anticoagulant requirements. Several universities are even looking at 3d Stem Cell printed bio valves. I'm sure the future will be nanobots that just go in and repair your native valve ;-)

Almost 10 years ago I made the same decision at 55. TAVR was the upcoming savior if one chose tissue at a age where replacement was a certainty. Well TAVR is not solution yet and for some, it's not a solution at all.. My advice is what my surgeon told me at the time, make your decision based upon today's reality not the future. That includes not just valve type, but the reality of your health insurance, family disruption, and job stability.

 

[nobog]

I require AVR + Ascending Aorta replacement + .... Several universities are even looking at 3d Stem Cell printed bio valves. I'm sure the future will be nanobots that just go in and repair your native valve ;-)

This has been on-going for decades.

 

[caro]

I had surgeons who brought up mechanical, bio or Ross. I second the advice to choose whatever makes you sleep at night. After I ruled out Ross, I took a couple months to read everything I could about both mech and bio valves, and I talked to people about both options. After doing this, my friend had me close my eyes and pick a choice at random basically out of a hat. I read it out loud and immediately asked “can I pick again?” Deep down I already knew the valve I wanted but this helped me realize it was also a choice I would not regret.

 

[dornole]

There's lots of info on valve choice and people's rationales on here and you can determine what makes sense to you. I would definitely put the psychological and emotional impact of repeated surgical procedure(s) into the decision-making mix in your case, even if they are TAVR (not guaranteed), I'm not sure you want to go through it more than once. Mechanical is more likely to be a one and done. You and I are about the same age and if they told me it was "go time" today, I personally would choose mechanical to hopefully last a lifetime. The experts on the forum have convinced me that I can handle being on warfarin, and with my risk factors (age 53, rheumatic heart disease, female) I doubt a tissue would last more than 5-7 years. On the downside you do have to test INR when you have a mechanical, are you phobic about finger sticks?

The one other thing I'd say is most people say don't try to pick a brand of valve after you make the tissue/mechanical choice, let the surgeon choose based on your anatomy and what she or he is used to placing.

 

[JannerJohn]

I think deep down I really can't face being on Warfarin or the ticking. I'm thinking the Edwards Resilia may be the option if I get 15y out of it plus a couple a TAVR then that could be an option but no guarantees obviously. No firm choice has been made yet.

 

[pellicle]

No firm choice has been made yet.

its my view that if one finds oneself preferring one over the other, then reversing that position, then reversing that again its simply a good sign that one is truly evaluating the position.

Jordan Peterson puts it this way: that when discussing something with someone you first need to really listen to the other person and understand their point of view. Analyse it, then explain it back to them. From there (once you do understand their view) you can begin to discuss what you differ on and why.

It is in this way that you can best show the other that you respect their view.

The decision process you have on valve type is really a dialog with yourself, and so in respect of yourself (and the honest search for "truth" as you see it) understanding the other side of the coin will often result in you agreeing with some of it.

Personally I have found many times that what you think "you couldn't do" are simply limits you impose on yourself at a particular time. You may never go past those limitations, but its always nice to think you can.

I'm sure not as limited as I was when I was 15

I post it around here a lot, so its no harm in taking up a few more bytes of storage with posting it again here

https://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html
Its often the case that the first shock we get that we are now past the peak and are on the run into aging is the hardest one. I recall well my feeling of being aware that I was now on my first daily drug that I'd need to live. In reality it was not as ominous as I felt it to be, but it was just the first time it had become something of clarity.

Warfarin is not hard to manage and indeed thousands have gone for decades (yes, each individual) and taken warfarin without even really being well managed at all ... management is nowadays simple and straightforward. If you choose to examine this path then the following lengthy post serves as a reference (one which I myself use from time to time) in managing that myself.

http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
Lastly, I'll leave you with a quote from Jordan Petersons book "12 Rules for Life"

"Once we can see the future we must prepare for it, or live in denial and terror"

I believe that you are now seeing the future and also that you are taking the steps for preparing.

Best Wishes

 

[Chuck C]

I require AVR + Ascending Aorta replacement + possible root (They all said they will see once the bonnet is open). I have spoken to three surgeons and had three answers. 1. Definitely Mechanical at your age (50y) 2. Latest generation Tissue with future TAVRx2 possible or 3. What ever you want I'll fit. The fundamental question is Mechanical or Tissue. The options as best I can tell are: Mechancal: St Judes, Carbomedics or On-X. Tissue appears to be the Edwards Resilia Valve.

I know this is a very emotive and well trodden issue so I am trying to apply some logic to it.

Somewhat frustratingly I don't think this will be a question in ten years time for people as I would guess the Polymer valve technologies in the pipeline will hopefully provide lifetime durability with no Anticoagulant requirements. Several universities are even looking at 3d Stem Cell printed bio valves. I'm sure the future will be nanobots that just go in and repair your native valve ;-)

We are similar in age, I'm 53 and am facing both the question of getting the surgery now, while I am asymptomatic or waiting for symptoms, and also mechanical valve or biological. I will share with you my thought process on the subject, which way I have leaned and which way I am leaning now.
Originally, after watching a long presentation regarding the Edwards Resilia, and how it looked promising for delaying calcification and SVD (structural valve deterioration), I read up on everything I could on the Resilia. I leaned heavily towards getting a Resilia biological valve for the following reeasons:
-I'm very active in combat sports, which would be totally out, except going light, if I choose mechanical, as I would be on warfarin. The nice thing about a biological valve is that, most likely, I would be able to resume all of my hard core contact activities
-I researched about rehospitalizations from warfarin and this was very concerning. One study found an annual risk of hospitalization from bleeding due to warfarin at 4% per year- that is 40% chance in the next decade and this really deterred me
-Biological valves are expected to last about 10 years for people our age, but there is hope that the Edwards Resilia may last longer, due to the anti-calcification treatment
-Long term survivability is claimed to be the same regardless of valve choice.

I would say that I had about 90% made up my mind to go this way. But, I have shifted my view for the following reasons:

-Having listened to many share their warfarin experiences I think that there are many misconceptions about it. While certain activities would be out, people can live very active lives.
-The numbers for rehospitalizations drop drastically, if you self manage your INR and if you keep taking your medication. One study found that about 50% of people who are prescribed warfarin stop taking it- which Pellicle has linked recently in another thread. There was another study published that found rehospitalizations for bleeding about the same for mechanical and biological for those who carefully control their INR. Another study, again thanks to Pellicle, showed that the vast majority of bleeding events happen at INR on the high end out of range and the vast majority of clots happen at the low end, out of ideal INR range- one has to wonder how many of those stopped taking their medications altogether.
-I don't agree that long term outcomes are the same. The evidence seems to suggest that mechanical valves have better long term outcomes. Take a listen to this presentation by Dr. Hertzell Schaff of the Mayo Clinic- again, thank you Pellicle.


- While there is hope that the Resilia will last longer, I can't base my decision on hope. There are only 5 year outcomes published so far on the Resilia and without additional evidence, I have to assume it will only last 10 years. This is standard for biological valves in patients my age, and for some people under 60 they only lasts 6-9 years.
- I have no problem testing weekly and even daily to self monitor INR. I am the type that likes to graph my health metrics and could see myself being diligent about this.
-I would still be able to do many of my thrill seeking activities and look forward to adding more
-I want to see my kids grow up and my grandkids too. I don't want repeat surgeries.
- Playing out the numbers for future surgeries, it does not look good once you get to the third if you go biological. SAVR at 53, then valve in valve TAVR at about 63. The hope is that the TAVR will last 10 years, which is certainly not known, esp for younger patients. Then, if I do manage to get 10 years out of TAVR at age 73, I am now facing TAVR in TAVR, which at this point is valve in valve in valve. That's a lot of junk in the valve space point there and the AVA is now just a small opening. It is probably like starting out after surgery with moderate stenosis. How long will that second TAVR last? Unknown. What complications? How active will I be able to be at that point?
Before anyone thinks that having a valve in valve in valve at a relatively young age is a good idea, please listen to this talk between Lars Svensson and Doug Johnson of the Cleveland Clinic. Lars cautions about people in their 40s and 50s getting biological valves with the plan to go TAVR on the second one, which he says will complicate things going into a third operation. He believes those in 40s or 50s are better off going SAVR then SAVR before going TAVR. Having talked to my cardiologist about TAVR in TAVR, to me that is something that I personally want to avoid unless I was 85+ or so. At 73, I plan to be very active and really don't like the idea of TAVR in TAVR. If either of my first valves don't last the expected 10 years, I could be facing the third operation at even younger than 73.
Listen to this talk, and if you want to jump right to the comments by Lars Svensson in this regard jump to 8:30 point in the video. BTW, Lars is one of the most highly regarded surgeons out there:


So, at this point I am now leaning about 90% mechanical as my choice and may yet shift again. I am going in for a consult in a couple hours with my surgeon. He was a consultant to Edwards for the Resilia valve, and I expect he may come up with some good arguments why I might want to consider it again.

 

[pellicle]

by Dr. Hertzell Schaff of the Mayo Clinic- again, thank you Pellicle.

you're totally welcome

 

[JannerJohn]

its my view that if one finds oneself preferring one over the other, then reversing that position, then reversing that again its simply a good sign that one is truly evaluating the position.

Jordan Peterson puts it this way: that when discussing something with someone you first need to really listen to the other person and understand their point of view. Analyse it, then explain it back to them. From there (once you do understand their view) you can begin to discuss what you differ on and why.

It is in this way that you can best show the other that you respect their view.

The decision process you have on valve type is really a dialog with yourself, and so in respect of yourself (and the honest search for "truth" as you see it) understanding the other side of the coin will often result in you agreeing with some of it.

Personally I have found many times that what you think "you couldn't do" are simply limits you impose on yourself at a particular time. You may never go past those limitations, but its always nice to think you can.

I'm sure not as limited as I was when I was 15

I post it around here a lot, so its no harm in taking up a few more bytes of storage with posting it again here

https://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html
Its often the case that the first shock we get that we are now past the peak and are on the run into aging is the hardest one. I recall well my feeling of being aware that I was now on my first daily drug that I'd need to live. In reality it was not as ominous as I felt it to be, but it was just the first time it had become something of clarity.

Warfarin is not hard to manage and indeed thousands have gone for decades (yes, each individual) and taken warfarin without even really being well managed at all ... management is nowadays simple and straightforward. If you choose to examine this path then the following lengthy post serves as a reference (one which I myself use from time to time) in managing that myself.

http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
Lastly, I'll leave you with a quote from Jordan Petersons book "12 Rules for Life"

"Once we can see the future we must prepare for it, or live in denial and terror"

I believe that you are now seeing the future and also that you are taking the steps for preparing.

Best Wishes

The Edwards was a recommendation from Ulrich Rosendhal

We are similar in age, I'm 53 and am facing both the question of getting the surgery now, while I am asymptomatic or waiting for symptoms, and also mechanical valve or biological. I will share with you my thought process on the subject, which way I have leaned and which way I am leaning now.
Originally, after watching a long presentation regarding the Edwards Resilia, and how it looked promising for delaying calcification and SVD (structural valve deterioration), I read up on everything I could on the Resilia. I leaned heavily towards getting a Resilia biological valve for the following reeasons:
-I'm very active in combat sports, which would be totally out, except going light, if I choose mechanical, as I would be on warfarin. The nice thing about a biological valve is that, most likely, I would be able to resume all of my hard core contact activities
-I researched about rehospitalizations from warfarin and this was very concerning. One study found an annual risk of hospitalization from bleeding due to warfarin at 4% per year- that is 40% chance in the next decade and this really deterred me
-Biological valves are expected to last about 10 years for people our age, but there is hope that the Edwards Resilia may last longer, due to the anti-calcification treatment
-Long term survivability is claimed to be the same regardless of valve choice.

I would say that I had about 90% made up my mind to go this way. But, I have shifted my view for the following reasons:

-Having listened to many share their warfarin experiences I think that there are many misconceptions about it. While certain activities would be out, people can live very active lives.
-The numbers for rehospitalizations drop drastically, if you self manage your INR and if you keep taking your medication. One study found that about 50% of people who are prescribed warfarin stop taking it- which Pellicle has linked recently in another thread. There was another study published that found rehospitalizations for bleeding about the same for mechanical and biological for those who carefully control their INR. Another study, again thanks to Pellicle, showed that the vast majority of bleeding events happen at INR on the high end out of range and the vast majority of clots happen at the low end, out of ideal INR range- one has to wonder how many of those stopped taking their medications altogether.
-I don't agree that long term outcomes are the same. The evidence seems to suggest that mechanical valves have better long term outcomes. Take a listen to this presentation by Dr. Hertzell Schaff of the Mayo Clinic- again, thank you Pellicle.


- While there is hope that the Resilia will last longer, I can't base my decision on hope. There are only 5 year outcomes published so far on the Resilia and without additional evidence, I have to assume it will only last 10 years. This is standard for biological valves in patients my age, and for some people under 60 they only lasts 6-9 years.
- I have no problem testing weekly and even daily to self monitor INR. I am the type that likes to graph my health metrics and could see myself being diligent about this.
-I would still be able to do many of my thrill seeking activities and look forward to adding more
-I want to see my kids grow up and my grandkids too. I don't want repeat surgeries.
- Playing out the numbers for future surgeries, it does not look good once you get to the third if you go biological. SAVR at 53, then valve in valve TAVR at about 63. The hope is that the TAVR will last 10 years, which is certainly not known, esp for younger patients. Then, if I do manage to get 10 years out of TAVR at age 73, I am now facing TAVR in TAVR, which at this point is valve in valve in valve. That's a lot of junk in the valve space point there and the AVA is now just a small opening. It is probably like starting out after surgery with moderate stenosis. How long will that second TAVR last? Unknown. What complications? How active will I be able to be at that point?
Before anyone thinks that having a valve in valve in valve at a relatively young age is a good idea, please listen to this talk between Lars Svensson and Doug Johnson of the Cleveland Clinic. Lars cautions about people in their 40s and 50s getting biological valves with the plan to go TAVR on the second one, which he says will complicate things going into a third operation. He believes those in 40s or 50s are better off going SAVR then SAVR before going TAVR. Having talked to my cardiologist about TAVR in TAVR, to me that is something that I personally want to avoid unless I was 85+ or so. At 73, I plan to be very active and really don't like the idea of TAVR in TAVR. If either of my first valves don't last the expected 10 years, I could be facing the third operation at even younger than 73.
Listen to this talk, and if you want to jump right to the comments by Lars Svensson in this regard jump to 8:30 point in the video. BTW, Lars is one of the most highly regarded surgeons out there:


So, at this point I am now leaning about 90% mechanical as my choice and may yet shift again. I am going in for a consult in a couple hours with my surgeon. He was a consultant to Edwards for the Resilia valve, and I expect he may come up with some good arguments why I might want to consider it again.

Your right it is one very major decision that requires very careful consideration. Warfarin aside one surgeon who I may use is one of Europes leading Aorta and Valve specialsts (Ulrich Rosendahl of the Royal Brompton Hospital) he said that the majority of his patients above 50 are going now with the Resilia valve. Yes its a calculated risk but if it did last 20-25ys then that would be a good result with maybe next generation TAVR. He also said he has had some mechanical valve patients begging him to replace them because of the ticking in particular those with Ascending Aorta grafts that apparently just acts as an amplifier for the ticking in a lot of patients.

 

[Superman]

The Edwards was a recommendation from Ulrich Rosendhal

Your right it is one very major decision that requires very careful consideration. Warfarin aside one surgeon who I may use is one of Europes leading Aorta and Valve specialsts (Ulrich Rosendahl of the Royal Brompton Hospital) he said that the majority of his patients above 50 are going now with the Resilia valve. Yes its a calculated risk but if it did last 20-25ys then that would be a good result with maybe next generation TAVR. He also said he has had some mechanical valve patients begging him to replace them because of the ticking in particular those with Ascending Aorta grafts that apparently just acts as an amplifier for the ticking in a lot of patients.

They have been saying tissue followed by TAVR for a while now. Somebody eventually will get to say, “I told you so.” I sincerely hope that comes to pass.

My oldest has a mild presentation of BAV. Hoping he’s like a lot of you where he makes it to his 50’s or 60’s before he has to worry about intervention. He’s still a teenager. Would love it if things progress to a couple TAVR’s that last 15 - 20 years each by the time he needs anything.

Just because OHS is survivable and living with warfarin is manageable, doesn’t mean I’d wish it on anyone. Particularly my own son.

 

[user 15848]

I think deep down I really can't face being on Warfarin or the ticking. I'm thinking the Edwards Resilia may be the option if I get 15y out of it plus a couple a TAVR then that could be an option but no guarantees obviously. No firm choice has been made yet.

There is no wrong choice, we all went through this process here, probably during first 3 months i heard the tick, now, 5 years down the road, i dont hear anything; nor my wife. Some one here once said "The fact is, we have a problem, and the fix is Surgery, how many times you want to go back to a hospital and put your family through this process again ? "... and no matter which way you go, life will never be what it was when were 15; one you take a pill and do test ( i do mine every 10 days at home, just because i eat the same thing every day..., yeah , i know.... ), or take the other road and be back at the cardio office every six months to check on the status of the "thing", since the Chineese Flu hit in November-2019 i have seen no doctors, my mechanical valve, will be there even after i am not.... "my surgeon said.... ", just " my " Perspective..... , no rights or wrongs here

 

[FishnFool]

I choose the Resilia Valve. I know its a risk and after being on here daily for the last 5 months I recognize that mechanical may have been the best choice for a 55 year old man. The others here are a wealth of knowledge when it comes to valves.

The main Honest reason why I went with Resilia. I workout daily and travel a lot, I love my toes in the sand with a cold beer. I also enjoy a few drinks every night. Warfin and alcohol do not mix well. So for me I went with the Resilia. I know some may think that is crazy. I have never been accused of being sane.

My valve is not that quiet. If am reading in my chair (which I do daily). I can hear it and feel it. When I sleep on my back I can hear it, it drives me crazy at times. But I can deal with that.

All in all I beat cancer at 28, I had my AVR in November. I am living my life and loving my new found energy. I made the right choice for me for now. Time will tell about the valve.

I wish you the best and I am glad to see you thinking this through.

 

[Unicusp]

We are similar in age, I'm 53 and am facing both the question of getting the surgery now, while I am asymptomatic or waiting for symptoms, and also mechanical valve or biological. I will share with you my thought process on the subject, which way I have leaned and which way I am leaning now.
Originally, after watching a long presentation regarding the Edwards Resilia, and how it looked promising for delaying calcification and SVD (structural valve deterioration), I read up on everything I could on the Resilia. I leaned heavily towards getting a Resilia biological valve for the following reeasons:
-I'm very active in combat sports, which would be totally out, except going light, if I choose mechanical, as I would be on warfarin. The nice thing about a biological valve is that, most likely, I would be able to resume all of my hard core contact activities
-I researched about rehospitalizations from warfarin and this was very concerning. One study found an annual risk of hospitalization from bleeding due to warfarin at 4% per year- that is 40% chance in the next decade and this really deterred me
-Biological valves are expected to last about 10 years for people our age, but there is hope that the Edwards Resilia may last longer, due to the anti-calcification treatment
-Long term survivability is claimed to be the same regardless of valve choice.

I would say that I had about 90% made up my mind to go this way. But, I have shifted my view for the following reasons:

-Having listened to many share their warfarin experiences I think that there are many misconceptions about it. While certain activities would be out, people can live very active lives.
-The numbers for rehospitalizations drop drastically, if you self manage your INR and if you keep taking your medication. One study found that about 50% of people who are prescribed warfarin stop taking it- which Pellicle has linked recently in another thread. There was another study published that found rehospitalizations for bleeding about the same for mechanical and biological for those who carefully control their INR. Another study, again thanks to Pellicle, showed that the vast majority of bleeding events happen at INR on the high end out of range and the vast majority of clots happen at the low end, out of ideal INR range- one has to wonder how many of those stopped taking their medications altogether.
-I don't agree that long term outcomes are the same. The evidence seems to suggest that mechanical valves have better long term outcomes. Take a listen to this presentation by Dr. Hertzell Schaff of the Mayo Clinic- again, thank you Pellicle.


- While there is hope that the Resilia will last longer, I can't base my decision on hope. There are only 5 year outcomes published so far on the Resilia and without additional evidence, I have to assume it will only last 10 years. This is standard for biological valves in patients my age, and for some people under 60 they only lasts 6-9 years.
- I have no problem testing weekly and even daily to self monitor INR. I am the type that likes to graph my health metrics and could see myself being diligent about this.
-I would still be able to do many of my thrill seeking activities and look forward to adding more
-I want to see my kids grow up and my grandkids too. I don't want repeat surgeries.
- Playing out the numbers for future surgeries, it does not look good once you get to the third if you go biological. SAVR at 53, then valve in valve TAVR at about 63. The hope is that the TAVR will last 10 years, which is certainly not known, esp for younger patients. Then, if I do manage to get 10 years out of TAVR at age 73, I am now facing TAVR in TAVR, which at this point is valve in valve in valve. That's a lot of junk in the valve space point there and the AVA is now just a small opening. It is probably like starting out after surgery with moderate stenosis. How long will that second TAVR last? Unknown. What complications? How active will I be able to be at that point?
Before anyone thinks that having a valve in valve in valve at a relatively young age is a good idea, please listen to this talk between Lars Svensson and Doug Johnson of the Cleveland Clinic. Lars cautions about people in their 40s and 50s getting biological valves with the plan to go TAVR on the second one, which he says will complicate things going into a third operation. He believes those in 40s or 50s are better off going SAVR then SAVR before going TAVR. Having talked to my cardiologist about TAVR in TAVR, to me that is something that I personally want to avoid unless I was 85+ or so. At 73, I plan to be very active and really don't like the idea of TAVR in TAVR. If either of my first valves don't last the expected 10 years, I could be facing the third operation at even younger than 73.
Listen to this talk, and if you want to jump right to the comments by Lars Svensson in this regard jump to 8:30 point in the video. BTW, Lars is one of the most highly regarded surgeons out there:


So, at this point I am now leaning about 90% mechanical as my choice and may yet shift again. I am going in for a consult in a couple hours with my surgeon. He was a consultant to Edwards for the Resilia valve, and I expect he may come up with some good arguments why I might want to consider it again.

You summarized my recent thought process very well. And Lars was my surgeon. Just completed surgery 1 week ago today. Wanted one and done. Lars did recommend the Resilia at first for me since I am also very active. At 59 I'm in better shape then 90% of my kids friends who are early 30's. Ultimately got the On-X and have zero regrets. I could not handle the unpredictability of when my tissue valve would fail. Could be 15 years, and also could be 5 years. That's unacceptable to me. Recuperation going very well and quickly. With self testing I see no issue with Warfarin. Plus, it has been on the market for so long, much long term data is available. It is proven safe and effective. Unlike Eliquis would is currently in clinical trials. I'd wait for that option until proven safe and effective.
And yes this is a very tough personal decision, but I looked at it from the logical perspective, for me.

 

[Chuck C]

"I could not handle the unpredictability of when my tissue valve would fail. Could be 15 years, and also could be 5 years"

So great to hear from you after your surgery, and it sounds like you are doing well!
It is a tough choice for folks in their 50s, like us, but this is my thinking as well. The last 20 months I have had 5 echos, and it is no fun getting that news that the valve has worsened on each echo. In fact, it really sucks. The thought that the bio valve might only last 5-8 years before I start getting news of deterioration and calcification, and then, once again, start that process of increasingly bad news every 6 months. That is something that weighs heavily on me. Despite some of the horror stories, such as those passed on by the Dr. Anyanwu video, warfarin seems very manageable to me and would allow for an active life.