If you can handle managing your INR, get the mechanical. But...
When I got my Epic bioprosthetic 10 years ago at 44, I made that choice because I was an emotional wreck, and not just because of my coming surgery. I was the guy who freaked out when my salt water aquarium chemical levels would go wonky. How was I going to manage INR?
Obsessively, for sure. I just wanted life to go back to normal as much as possible. Now on the other side, do I regret it? Mostly no, because it was what I needed at the time.
Really, in the first half of your 40s there's no right choice. My surgeon was a god with a scalpel and he, among other doctors, could not give me enough of an answer to solidly help me choose wither way. Statistically, the choice didn't really matter. I was young enough that I might need a mechanical replaced any way. So, I figured it this way, if all went well, I could get 15 or even 20 out of this bio valve (going strong so far at 10 years). That'd put me at 60 or 65 when it's time to replace it. I'll have a 2nd OHS at a age very commonly successful for such procedures and get a mechanical valve. If all goes nearly as well as my first valve, I'm done for the rest of my life.
Even better, at the time TAVR was causing strokes like it was a surgery meant to cause strokes. Today's TAVR outcomes are often reported with insignificant differences in outcomes from OHS/SAVR. So if I can do that at 60+, at least another 5 years for TAVR to improve, even better for my aging body. (In full disclosure, there are also studies about those TAVR studies that say those studies are lacking in rigor... If there's one thing I've learned about statistics and heart valve replacement, it's that... heck, who the F- knows. Read what you can. Listen to your gut and @pellicle always has good wisdom to share.)
When I got my Epic bioprosthetic 10 years ago at 44, I made that choice because I was an emotional wreck, and not just because of my coming surgery. I was the guy who freaked out when my salt water aquarium chemical levels would go wonky. How was I going to manage INR?
Obsessively, for sure. I just wanted life to go back to normal as much as possible. Now on the other side, do I regret it? Mostly no, because it was what I needed at the time.Really, in the first half of your 40s there's no right choice. My surgeon was a god with a scalpel and he, among other doctors, could not give me enough of an answer to solidly help me choose wither way. Statistically, the choice didn't really matter. I was young enough that I might need a mechanical replaced any way. So, I figured it this way, if all went well, I could get 15 or even 20 out of this bio valve (going strong so far at 10 years). That'd put me at 60 or 65 when it's time to replace it. I'll have a 2nd OHS at a age very commonly successful for such procedures and get a mechanical valve. If all goes nearly as well as my first valve, I'm done for the rest of my life.
Even better, at the time TAVR was causing strokes like it was a surgery meant to cause strokes. Today's TAVR outcomes are often reported with insignificant differences in outcomes from OHS/SAVR. So if I can do that at 60+, at least another 5 years for TAVR to improve, even better for my aging body. (In full disclosure, there are also studies about those TAVR studies that say those studies are lacking in rigor... If there's one thing I've learned about statistics and heart valve replacement, it's that... heck, who the F- knows. Read what you can. Listen to your gut and @pellicle always has good wisdom to share.)
