Alex,
I've been in your shoes. I had my aortic valve replaced and my ascending aorta repaired with a conduit eight years ago when I was 41 years old. I quizzed two surgeons and several cardiologists. The surgeons were consistent in saying they personally would rather have another operation and avoid warfarin (tissue valve) if they were the patient. The cardiologists preferred warfarin and only one operation (mechanical valve). I chose the Edwards bovine pericardial valve, planned on having another AVR operation, hoped for 15 good years or more before reoperation and went right on leading an active lifestyle - riding my bike, climbing ladders, drinking beer, eating whatever I wanted and not thinking about my valve (took a baby aspirin every day). After only eight years, my tissue valve became severely calcified and narrowed and I had it replaced 7 weeks ago with a mechanical valve at the age of 49. I now take warfarin and have had no problems yet. I am making some concessions. I'm not riding my bike in traffic and I don't go off-trail anymore. I took my bike to the park tonight and rode ten miles on the paved trails. I don't think I'll be climbing tall ladders anymore and I rarely drink alcohol.
For the re-operation, I had the same surgeon again and we discussed valve choice. Since we still don't know why my first valve failed quicker than average (even considering my relatively young age), we have to assume there's something different about my metabolism or immune system. My very wise surgeon advised me that we could continue to do tissue valves but they would probably calcify again and I would have at least several more operations after this one. I chose the mechanical valve this time. I don't regret my first valve choice or this one.
Do your homework, decide what's important to you and make your choice. If you choose the tissue valve, you can go on with all the same activities without concession, plan for another operation down the road, and hope the valve lasts a long time (it might). If you choose the mechanical valve and take warfarin, you would be wise to make some common sense concessions with your activities. Personally, now that I'm on warfarin, I would not want to overturn a kayak in a boulder-strewn stream or crash my bike into a tree stump. A heavy blow to the head in the back country while on blood thinners, would be extremely serious and could put me in the grave or a nursing home for life.
Like the others who have responded to your question, I'm not advocating either valve for you. I've had both and been happy either way. This time, I've been willing to make the lifestyle adjustments. Although my second AVR operation was easier than my first, and the recovery has been very smooth, I wouldn't want to do this two or three more times (at 59, 69 and 79). The older the patient, the higher the mortality and morbidity risk of open heart surgery.
Good luck!
Edwards pericardial tissue aortic valve and ascending aorta conduit in 2004 by Dr. Bruce Lytle at the Cleveland Clinic. Pacemaker in 2006 for bradycardia. Re-do aortic valve replacement with On-x mechanical valve on July 3, 2012 by Dr. Lytle at Cleveland.
I've been in your shoes. I had my aortic valve replaced and my ascending aorta repaired with a conduit eight years ago when I was 41 years old. I quizzed two surgeons and several cardiologists. The surgeons were consistent in saying they personally would rather have another operation and avoid warfarin (tissue valve) if they were the patient. The cardiologists preferred warfarin and only one operation (mechanical valve). I chose the Edwards bovine pericardial valve, planned on having another AVR operation, hoped for 15 good years or more before reoperation and went right on leading an active lifestyle - riding my bike, climbing ladders, drinking beer, eating whatever I wanted and not thinking about my valve (took a baby aspirin every day). After only eight years, my tissue valve became severely calcified and narrowed and I had it replaced 7 weeks ago with a mechanical valve at the age of 49. I now take warfarin and have had no problems yet. I am making some concessions. I'm not riding my bike in traffic and I don't go off-trail anymore. I took my bike to the park tonight and rode ten miles on the paved trails. I don't think I'll be climbing tall ladders anymore and I rarely drink alcohol.
For the re-operation, I had the same surgeon again and we discussed valve choice. Since we still don't know why my first valve failed quicker than average (even considering my relatively young age), we have to assume there's something different about my metabolism or immune system. My very wise surgeon advised me that we could continue to do tissue valves but they would probably calcify again and I would have at least several more operations after this one. I chose the mechanical valve this time. I don't regret my first valve choice or this one.
Do your homework, decide what's important to you and make your choice. If you choose the tissue valve, you can go on with all the same activities without concession, plan for another operation down the road, and hope the valve lasts a long time (it might). If you choose the mechanical valve and take warfarin, you would be wise to make some common sense concessions with your activities. Personally, now that I'm on warfarin, I would not want to overturn a kayak in a boulder-strewn stream or crash my bike into a tree stump. A heavy blow to the head in the back country while on blood thinners, would be extremely serious and could put me in the grave or a nursing home for life.
Like the others who have responded to your question, I'm not advocating either valve for you. I've had both and been happy either way. This time, I've been willing to make the lifestyle adjustments. Although my second AVR operation was easier than my first, and the recovery has been very smooth, I wouldn't want to do this two or three more times (at 59, 69 and 79). The older the patient, the higher the mortality and morbidity risk of open heart surgery.
Good luck!
Edwards pericardial tissue aortic valve and ascending aorta conduit in 2004 by Dr. Bruce Lytle at the Cleveland Clinic. Pacemaker in 2006 for bradycardia. Re-do aortic valve replacement with On-x mechanical valve on July 3, 2012 by Dr. Lytle at Cleveland.