Regarding tissue valves, I'm not certain I agree that the Magna (CEPM) will give better blood flow that the porcine models, but I agree that it would be equivalent. The CEPM would be likely to last a bit longer, based on history.
If your husband does not require his aortic root to be replaced, the Carpentier-Edwards Perimount Magna or the Medtronics Mosaic should do just fine. If he does require root replacement, the Medtronics Freestyle is probably the most advanced tissue valve for that purpose currently available.
Lately, Medtronics has been heavily marketing the Freestyle for simple valve replacement as well. The Freestyle valve is adapted for the task by the surgeon on the spot, and the root is not replaced. It is a stentless solution, but as you point out, it's harder to remove for replacement later. There have been arguments pro and con stentless valves since the Toronto was introduced about 15-18 years ago. The stentless valves seemed to last a bit longer in younger patients vs. earlier versions of stented porcine valves, but that may no longer be the case.
Basically, stented valves provide as good a remodelling scenario (reduction of enlargements) for the heart as stentless porcine valves. This is because teh bloodflow difference betweenthe types has been lessened in stented valves by making the stent thinner, and positioning the valve slightly higher, where a larger size valve will fit. The jury is still out as to whether one type will last longer. Best guess right now from what history is available is that they will have equivalent lifespans.
Again, the cow pericardium valve (CEPM) currently has a history of lasting longer than the porcine valves.
If you're around 50 like me, and you want your replacement surgery before you're 70, the porcine valves can be a wise choice and a better strategy.
If you're younger, mid-40s or below you're looking for it to last as long as you can. In between, it's anybody' guess what's best.
Best wishes,
