@HokieHade
To share my experience: I had a bicuspid aortic valve, w/ mid-ascending aortic aneurysm. Bicuspid valve was really two leaflets fused together, possibly due to a virus during childhood, who knows. I had an aortic valve/root replacement at age 35 in 2002, with a brand-new-on-the-market CryoLife SynerGraft aortic valve (a human donor valve, washed of donor cells and cryopreserved, hoping that it would repopulate w/ my own cells for less "rejection" by my body). Got some dacron tubing for the aorta. My concern at that time was that I wanted to preserve the option to have children, and warfarin isn't so conducive to that. My cardiologist in DC wanted me to get a mechanical for longevity, saying that we can manage it w/ heparin, etc. But I ended up at Mayo Clinic, and got the tissue. Only med was baby aspirin.
As an aside: At the time of my surgery, they believed that the aneurysm was due to the hemodynamics of the blood coming through the valve at an angle and slamming into the wall of the aorta, causing the bulge. (Marfan's Syndrome was suspected, but ruled out during the actual surgery). But more recently, they are viewing the aneurysm and aortic root issue as a separate "disease", Aortic Root Dilation, and told me to have my siblings/children get checkout out, as it is believed to be hereditary, and a silent killer for those who aren't being monitored.
So, about 15 years in, my replacement valve was starting to leak, and I knew I'd need it replaced before I turned 60. In February 2021, about 19 years in, the echo showed that the valve was not just regurgitant, but also stenotic. One occurs when the heart contracts, the other when the heart expands. So we will continue to watch and wait. Then, October 2021 (two years ago this week!), I experienced some sort of "catastrophic event" where, because of the stenosis/calcification, my valve broke (blew a hole), totally failed, putting me straight into congestive heart failure. Later I was told that this is a rare event, it doesn't usually happen like this.
Thankfully (after 10 days of thinking I had pneumonia), I went to see my big dog cardiologist at Johns Hopkins, and a fantastic surgeon there. They also have a TAVR group. So there was much discussion on how to handle this. They wouldn't let me go home until I had the valve replaced.
1) I was in full-blown congestive heart failure.
2) Scar tissue. Yes. Lots of it. It took them an hour to cut through it all.
3) Everything in there was calcified, and a royal mess. Lots to remove before they could start putting new stuff in. Very delicate.
4) My aorta was calcified and positioned closely underneath my sternum. They were worried that they would break the aorta when they cut open the sternum, and that would be Bad News Bears. So they opted for a "clamshell incision", horizontally side-to-side under the breasts, then yank my rib cage open like the hood of a car. So the first surgery was the "crab", and the second, the "clam". HAHA!!
5) Much discussion was done about a TAVR, and the previous surgery notes were helpful in determining whether there was enough room in there to do a TAVR. They initially didn't think it was an option, but then this TAVR group decided it was.
6) Options: a tissue (I forget which), a TAVR, an On-X mechanical w/ the conduit attached (for the aorta).
Side note: I don't have my notes here, but I believe my tissue valve was 22 mm, and my current valve is 19mm, this is what the surgeon had to use for whatever reason. And I may be delusional, but I feel like I can notice this when doing stairs, etc. I feel it straining inside there, and feel winded, like I'm not getting enough oxygen during such exertion. But I can live with this.
Several things affected my decision, but at 54, my main concern was the longevity. Didn't want to do another tissue, as pregnancy isn't a concern now. For the mechanical, open heart surgery with the points I listed above, they said it was 10-15% chance of mortality. They didn't like doing surgeries more risky than 5%. In retrospect, I really don't think I could do a third such surgery, and with such risks at this age, I knew it would be worse in another 10 years. TAVR, my main concern was all of that calcification still in there. If I lay a tissue valve over top of it all, that will just add more to the glob of calcification. My valve broke, what else is gonna break, and when? It's dangerous to have a random chunk of calcification suddenly hit your bloodstream (stroke, death....) Once the surgeon explained to me what the mess was in there, I was like, I want all of that OUT. And I prayed for wisdom.
But all of us: big dog cardiologist, surgeon, previous surgeon (who did my SynerGraft, he was a former colleague), and me, we all decided on the mechanical. Later my cardiologist told me, referring to the TAVR, "we wouldn't have let you make the wrong choice". He was at another location during the time I was in the hospital, and he sort of hinted that they shouldn't even have offered me a TAVR. So, yeah. It would've been great to walk out of there and continue life for another 10 years, but then I'd be in the same boat again, only bigger and deeper.
Here's the On-X with conduit attached. This might be what your surgeon is suggesting for you?
https://artivion.com/product/on-x-aap/
I do home monitoring w/ a Philips CoaguCheck Vantus machine. I keep a box of fresh spinach in the fridge, to munch a bit as needed. My new cardiologist thinks that I can be in the 1.5 to 2.0 INR range, but I don't like that, and got him to change it to 1.5 to 2.5. Now there's another new cardiologist on the scene, and I hope to get him to change it to 2.0 to 3.0. I get bruised easily, and some small bleeds have been difficult to stop. I wear a bracelet to let emergency personnel know that I'm on warfarin. But, I can live with all this.
I wish you the best! Please don't hesitate to chat some more here!
Jennie
PS I miss my grapefruit