The problem is no one will guarantee a tissue valve will last a certain time no matter what your age, altho the have a better chance of lasting 15 or more years in a 50 year old than 27, OR noone can guarantee that if you get a mech valve you wont have a major clot or stroke. The real risk IMO to me is not What are the chances of having a REDO w/ a tissue valve, or a stroke or bled w/ a mech but what are the risks of having a BAD outcome w/ a REDO vs a BAD out come since you need Coumadin because a mech valve increases the risk of clots. There ARE risk of Bleeding or Clotting, even with the NEWEST Valves, Home testing, INRs and the best Doctors, there STILL is risk of a stroke for a clot or a stroke from a bleed. Just look at the results so far for he ON_X Proact trials.
Yes they are discovering more functions of the body that rely on Vit K.
and just like vit K plays an important role in Clotting with the vit k dependant proteins that Coumadin affects in the liver, they also are learning the role vit k plays in bone health or Arteries not calcifying, that Coumadin does affect the other roles Vit K plays a part in in other parts of the body So it is PROBABLY that, more than the fact people used to be told not to eat Vit K foods, that makes a difference in bone density and clalcified arteries. For the past decade or so they now know it is better to eat /take Vit K to help the INR be stable. But knowing how important the differen Vit Ks are is all pretty new. Also as everyone says, what you eat or dont eat, really doesnt affect the INR that much, just eat how you normally eat and adjust the amount of Coumadin needed to your normal diet. So beside the Ticking, blood work or increased risks of stroke or major bleeds, some people rather cut down on the years they will need to be on anticoagulants by getting a tissue valve now then seeing what is available when it needs replaced. There ARE risks every year you take anticoagulants for a mech valve, .but the math is a little different than you are talking about.
this is a good article. http://circ.ahajournals.org/content/117/2/253.full#ref-15 Choice of Prosthetic Heart Valve in Today’s Practice One of the interesting things in it is they take a 50 year old man and figure out the LIFE TIME Morbidity and mortality long term for each Choice, "Projected Future Risks After Aortic Valve Replacement in a 50-Year-Old Man, Assuming 30-Year Survival" taking into account the risk even if he had 2 REDO at various ages with a tissue valve and the risk of clots and bleeding in each decade of his life with a mechanical valve. Now of course it will be different for someone not quite 30, but I thought it was pretty good at explaining the different risks for each choice over the years.
TAVI, I'm not sure where the 5% mortality is from, unless that is from the earliest trials on just the sickest patients. I believe even now the risk is lower than that, about the same as a 1st time REDO, even with the highest risk patients, since they already have improved the valves and deployment systems and there is a learning curve, so even the later patients in the trials did better than the first couple the doctors did. BUt since they are so new and just starting to be done on healthier people who should have longer life spans, no one knows how long they last. FWIW the stats for people who had their TAVI valves 5 years the valves are still doing well, but older people tend to have tissue valves the longest.
IF you choose a tissue valve now, I would ask about what valves currently in use make it easiest to implant valves inside and which seem to be harder, to give myself the best chance of being able to get a valve in valve in 5-15 years or however long this tissue valve lasts. It IS better to have a larger valve, BUt I believe that you could only get 2 TAVI valves before they would have to replace your valve surgically, so even tho, they are doing TAVI and valve in valve now, I would plan on needing at least 1 more open heart surgery considering your age. Altho each valve you got would probably last a little longer than the previous as you get older still you would need a few valves if you live a long healthy life, IF you chose a tissue valve now, it is hard to tell what your options might be when it needs replaced, Maybe by that time there would be clearer picture of long term with either choice. Right now, beside all the time and money going into percutaneous valves, they also are working on better or in some people thoughts safer anticoagulants,and even tissue valves grown from the persons own cells (tissue engineered)
I do NOT know at all how different cost will be, yes the price of the valves themselves will probably go down, but beside the cost of the valve, considering you will probably have a shorter time in the hospital recovering from a cath than open heart surgery and the fact you will be able to go back to work much quicker from a TAVI valve probably balances out even with the higher cost of the valve. I'm sure the cost of another valve replacement, would be more than that many years of meds and blood work if you have a mechanical valve now But since there IS a risk of a bleed or clot that could be expensive too.
So all of that pretty much says both choices have their advantages and both choices have their risks, maybe it would help to decide which set of risks you rather live with and once you make up your mind, try not to second guess your self or ask what ifs.
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