Disclaimer - I'm not trying to convince you one way or another. I TOTALLY support those that have chosen a different path (I've gotten to be good friends with some of them on here in fact). I just feel a responsibility to share the results of my own personal research on this topic, because I think it's important to hear from both "sides". At the end, I'll also share what I've found to be the cons of the path I've chosen, having now been through it. To me, as long as you know what you're signing up for, either choice can be a good one. But it IS important to know what you're signing up for because there are pros and cons to each. It would suck if you didn't realize the ramifications of whichever choice you make, then down the road find out something that would have changed your mind. That's all many of us are trying to make sure of - that you know what you signed up for. Information is power...
So with that disclaimer, I'll give my personal opinions - and again, these are just my personal opinions (right or wrong). Others will disagree with me, and that's ok. You have to make your own decision on where you want to place your bets. This is just the background on why I selected the path I did.
Like you, I was originally leaning heavily towards tissue for the same reasons you mention (active, didn't want lifestyle changes, or to be on meds rest of my life, etc.). See my original post back in March:
http://www.valvereplacement.org/forums/showthread.php?34663-48-year-old-newbie-Lots-of-questions-to-come
After I wrote the above post in March, I had a long talk with my surgeon about topics including the Ross procedure, mechanical vs. tissue, minimally invasive approaches, etc. I believe him to be a very well respected valve replacement surgeon (great references, including me now, is involved in research on the newer techniques, etc.). He told me he would do a tissue on me if I really, really wanted but strongly advised against it, mainly due to my relatively young age (49). But he said if I wanted a Ross procedure, to go somewhere else - he wouldn't even do it. He told me that a surgeon buddy of his is the one who operated on Arnold Schwartzenegger and used the Ross procedure - it failed very quickly. And he said that's not at all uncommon with the Ross procedure in adults.
Some will argue with this, but he also told me the second surgery does carry an increased risk, and the 3rd one is significantly higher (something like 6% or 9% by the 3rd one). Those statistics that say 2nd surgeries have the same risk as the first may be true, although that doesn't really pass my common sense test (for the reasons Ross mentions above). But let's say it is true that the 2nd surgery has the same risk as the first. And let's say that risk is 2%. Well, if I'm doing my math right, by the time you've had your second surgery, you've subjected yourself to a 2% risk TWICE. In other words, since 2+2 = 4, my math says you've now had a 4% risk overall. And that's not to mention the financial impact of a second surgery. I've got great insurance so most of the $125,000+ was covered. But what if I'm layed off or something and don't have insurance 7 years from now... That all went through my head.
In addition, he told me the same thing I've heard from many of the experienced folks in here, which is that tissue valves don't last as long in younger folks. So instead of 10-15 years like I was hoping, he said it's more like 7 years for folks my age. Now, there will be several who argue that today's tissue valves last longer than that in younger folks. I just wasn't willing to take the chance.
And then, after talking to many that have been on Warfarin for decades with no issues, I began to realize it's not as bad as I first thought. I can now confirm (while I'm still new to the game) that it's usually not a big deal at all to be on Warfarin. None of my original fears (other than having to put up with periodic finger pricks - I hate needles) have proven true. You can drink (although probably smart to do it with some moderation), you can get a cut without bleeding to death, you don't bruise easily like I'd heard, you don't have to alter your diet, etc, etc.
So those were the Pros for the choice I made. Now, here are the cons of this choice (from someone who's now gone through it). The Warfarin does require you to monitor your INR, which means periodic finger pokes and it is important to remember to take your pill each day. There is a relatively small inconvenience if you cut yourself or otherwise start bleeding (i.e. scratch off a scab or something). That inconvenience is it takes about twice as long to stop the bleeding. There are some things that I'll think twice about now before doing (i.e. riding a motorcycle or getting a tattoo) but that doesn't mean I won't do them (in fact probably will still do both). I have been a little more careful with drinking (switching over to water or pop after 3 or 4 beers, instead of drinking 6 or 8). I do hear my valve ticking when I stop and think about it. Most of the time it's just white noise. It doesn't prevent me from falling asleep, but I am slightly concerned about someone sleeping w/ me - will it keep them up, esp. if they're laying on my chest, etc. Those are about the only cons I can think of so far. And for me, the pros of the mechanical choice outweighed the cons, so that's the direction I went (and am still happy about it). But again, there are others who are just as happy with the other choice. I'm all for that, as long as everyone knows what you're signing up for!
