Hi Cherie and welcome to the forum. First off, this is absolutely the best place to get your questions answered and get support. I ran across it back in late March, but have now become addicted to it!
On the question of tissue vs. mechanical, you'll find it's one of the more controversial issues on here. So you'll hear a lot of passionate replies from both camps. Below is my passionate reply - but remember, I'm just one guy. Others will likely echo what I'm saying, and others yet will have completely different, but just as legit replies. It's a very personal decision, and there is probably no right or wrong blanket answer that works for everyone.
I was initially leaning heavily towards tissue (see my original post -
http://www.valvereplacement.org/forums/showthread.php?34663-48-year-old-newbie-Lots-of-questions-to-come) because I didn't want to alter my lifestyle and because I'm terrible at remembering to take meds (or at least was before surgery). Plus, was afraid of bruising easily. In fact, I think I even mentioned in the link above the same approach you're thinking of - go tissue, live the next 15 years w/o any lifestyle changes, then go mechanical at that point. After some research, including talking to many on here as well as advice from my surgeon and cardiologist, I went mechanical. My surgeon probably made the most impact on my decision, followed closely by some here on the forum.
My surgeon said he would do a tissue if I really, really wanted, but he strongly recommended a mechanical due to my relatively young age (49). He said that while the survival rate from the initial surgery is very, very high, especially for folks that are pretty healthy and in the age range I'm in, the rate gets worse with subsequent surgeries. Reasons include a) you're older when you need the subsequent surgeries; and b) the first surgery takes a toll on your body (Ross will confirm) which makes subsequent surgeries a little more risky. He quoted me some numbers on subsequent surgeries, but I've found they're a little controversial on here, so will leave those off this time. But his reasoning passed my common sense test, so I bought in. Plus, there are other considerations to take into account with subsequent surgeries. The expense of the 2nd/3rd surgery, including the risk of no longer being insured by then (assuming you are now). The extra time off work. And just the emotional/physical toll of going through it a 2nd time. So in my case, I decided I didn't want to go through a second surgery if I could help it. And I know there's no guarantee, but my understanding is my valve will most likely out-live me, and I'm planning to live 'till I'm 98.
The other thing that changed my mind was I became convinced after talking to several on here that Coumadin isn't all that bad afterall. And so far, I'd say they were absolutely right. I've been on it for a little over 8 weeks now (my surgery was 5/5) and have had virtually zero issues with it so far. And to my surprise, with the help of a pill box and an alarm I set on my cell phone to remind me, I think I've only had one "mess-up" with any of my meds. And I'm one of the worst there is/was at remembering to take meds. I could go into detail about the things that I was afraid of that there really isn't a reason to be afraid of, but then my already-too-long post would be even longer. So if you wanna know more, private message me.
Oh, and the other, other thing that really had an impact on me, and again, this is controversial, but seems to be backed up by many here in the forum, is that in younger folks (<60) a tissue valve often doesn't last the 15-20 years I was originally hearing. In fact, they seem to often fail as early as 7 years. That might have been the tipping point for me as I think back. And you'll likely hear the other side here on the forum as well - which is that a) tissues are better now-a-days and last longer than the 7 years several on here have experienced; and b) there's a chance down the road with tissue, you'll be able to get it replaced with a less invasive procedure. And, there's some evidence that the cow valves (as opposed to pig valves) may last closer to 20 yrs. You'll have to decide for yourself which camp you believe. I decided I didn't want to take the chance on another surgery in 7 yrs.
On the ticking valve issue. I still hear mine most of the time if I stop and think about it. But it's basically like background/white noise. Doesn't bother me at all, even when trying to go to sleep. It does make the irregular beats I've had a little more obvious, but on the bright side, I can take my pulse now w/o feeling my wrist
Overall, if I had it to do all over again, I'd still go mechanical - very, very happy with that choice.
Hope that helps a little. Let me/us know if you have more questions - as I'm sure you will.
Oh, and the most important thing at this point (other than picking tissue vs. mechanical) is to realize that the surgery itself is usually nowhere NEAR as bad as you're likely fearing right now. I won't say it's a piece of cake, but compared to what I thought it was gonna be, it almost was for me. But again, as "easy" and smooth as mine went, I'm still happy I most likely don't have to go through another one later.
