One of the many studies I devoured before choosing my new AR, at 2 yrs older than you, showed overall life Life Expectancies for AV recipients, mechanical vs. tissue. (I think they were "pooled" results, but my memory is fuzzy. Maybe somebody's got a link handy?) Basically, the lines crossed, somewhere around our age. Older, and the tissue folks lived longer on average; younger, the mech folks lived longer.
That mortality included all causes, and (as I recall) the dominant risks from the mech valves weren't from the valve, but associated with the ACT. There's a small but non-zero incremental risk of strokes and such, for example. Whether that's a negligible or acceptable risk FOR YOU in return for having a valve that will itself last "forever", is part of your complex, personal, value-laden tricky decision. If your INR can be (and is) stabilized well, your risk is presumably lower than if it isn't. And the new "Gold Standard" study suggests that some tissue valves are starting to demonstrate and prove longer lifetimes than were found in this study.
Part of the difficulty is that we're all dealing with stats and probabilities -- but we're NOT stats and probabilities! Individual "anecdotal" cases matter a LOT to us, especially if we're the anecdote!!
I'm reminded of an old funny story: Seismological conference in Washington, DC. One of the delegates on another region asks one of the local experts what the probability is of experiencing a major earthquake right there in Washington, DC. The answer: "One in 10,000 years -- but if it happens tomorrow, you'll NEVER believe me again!" In reality, 1/10,000 events -- good ones and bad ones -- happen a lot. But they DON'T happen 10,000 times more often than that!
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