Some more ramblings...
Apart from the provocative, Patrick-Henry-esque statement (a closet Colonial! a prospective New Hampshirite!), I think the salient issues are your age and the understandably assumptive description of Life with Coumadin. I believe the latter has been addressed vigorously, and largely dispelled.
About the former: your age indicates that you would be subject (with today's technology) to at least three more open-heart surgeries for tissue valves after this one, assuming a standard life span, or perhaps two more and a catheter placement. And you've already had one OHS. There are risks inherent in multiple surgeries that make them a choice you want to limit, if at all possible. And you can't count out the possibility of other major surgeries ever happening in your life (see Nancy's husband). I think this is one of the things that triggers such a strong reaction of concern.
Could there be amazing changes in valve technology over the next ten years? Yes, there could. But realize that if there are, they are unlikely to be implemented in that short a time. It takes seven to ten years to implement a new technology of that sort, depending on where it is in the pipeline. It makes sense to base your choices on those things that have the highest chance of being available when you will need them. There is some chance that a current mechanical valve design, possibly ATS or On-X, will be approved to run on reduced or even aspirin-based ACT in that time.
If you determine that your need to live unfettered by warfarin over the next few years is immutable, then consider holding yourself open to the possibility of moving over to a mechanical when this one wears out. That is one of the reasons I pointed to Moo. He went with a tissue valve the first time, largely to give himself more time for uncluttered personal freedoms (and apparently to party a little longer).
The second time, he went with a mechanical valve for longevity. He has occasionally flabbergasted some members of this board with some of his personal experimentation while on warfarin. Yet, I believe it's valuable to hear the results of personal testing of limits, whether you condone airing them for fear of inappropriate emulation or not. After all, we are also eager to hear the results of those who go beyond the traditionally medically-advised limits to enter marathons and triathalons on warfarin, because we perceive those things as being positive.
About head trauma and warfarin: again, I point to the advanced age of the typical (average-age) valve recipient as being a skewing factor in this. I'm sure you realize that the chances of an intercranial bleed accelerate greatly with age regardless of warfarin use, and ACT aggravates this risk. In this same, expectant-age-related pattern, you will also note that the literature and recovery expectations given to you by the hospital as you leave are generally plainly written with an older audience in mind.
It's not that the warnings don't apply at all, but I personally believe they apply less aggressively to younger recipients. Sonny Bono and the Kennedy scion who died tragically in skiing accidents involving impacts with trees were not on warfarin. One has to wonder in this very protective (and insured) country how long it will be before all skiers are enjoined to wear protective helmets at commercial skiing establishments. The question hangs in the air: are these recommendations all really warfarin-related, or are they partly driven by a desire for all patients to be more safe in their activities? If a "normal" patient asked the doctor if it's safe to ski, wouldn't most doctors in your acquaintance say that they should wear a helmet..?
Philosophically, I agree with many of your sentiments. As I've said, my own decision to go with tissue valves is a result of not dissimilar thought processes. Through this site, my appreciation has grown for the understanding that for the young, Coumadin is not the monster that it is often described. But it is not nothing, either. It would seem unfair to say otherwise. There are some adjustments that go with it, and frustrations.
However, it's also only fair to point out that the mechanics and risks of the tissue solution plainly work out more to the advantage of those who have their first surgery at an older age. If you take those understandings to heart and add them to your thought process, you can balance your decision more accurately. I'm not saying to go mechanical. Or to go tissue. I'm saying that whatever decision you make is best with your eyes as open as you can stand to make them.
About atrial fibrillation: my understanding is that there are some things that affect the likelihood of it:
- People who have mitral valve surgery stand a slightly greater chance of experiencing afib afterwards than those with aortic replacements. Apparently, there is a somewhat more conductively-sensitive area involved in that surgery.
- People who've had more heart surgeries increase their risk. More scar tissue equals a greater chance of developing afib.
- Age is a factor. The younger you are, the less the likelihood of afib after surgery. People above the classic retirement age stand at greatest risk of it. As the vast bulk of people who have valve surgeries fall into that bracket, it seems unlikely that the 30% rate you mention is appropriate to your particular age and situation. Most studies are not adjusted to age-appropriate risk levels.
However, risk factors are just that: statistical possibilities. In real life, they are applied quite unevenly to the universe of OHS recipients. It's important that we all maintain a view of alternatives and possibilities, and premeditate our responses to "what do I do if..." situations that may come up.
If we do not choose, the choices will be made for us. Please deliver me from those who want to do what's best for me, for those who seem most eager to make those decisions so rarely understand what that is...
Best wishes,
Only Joking.
