This is a rather tedious, for the reader, recounting of the path I followed in, first, identifying the decisions that were mine to make, and second, making them. I am not, in these paragraphs, actually reporting my conclusions. It isn't worth reading unless you are in the process of sorting through the same variables, and collecting all the information you can to that end.
I had some time--well, I TOOK some time--to (a) understand the disease, and (b) explore my options. I decided not to waste time reading about post-surgery or recovery, questions that could be answered another day if I was lucky. My cardiologist and cardiothoracic surgeon gave me the time I needed to feel comfortable about my decisions. I now know I waited a little too long, they were both a little uneasy, but I never felt pushed ahead of my readiness.
When I understood the medical problem, I also understood that the decision of the moment--the one that, made now, would have lifelong consequences--was valve choice, and focused my reading on outcome research comparing results as related to valve type. Most influential, in the end, were some 2007 and early 2008 meta-analyses of outcome data. In my reading, I formed a strong opinion, but as Leah says, I had no illusion that I could competently make a final decision by myself.
Early on, I let go of the brand-name question. Most data regarding specific brands appeared in single-brand studies, many of them funded by the manufacturer, and might not be totally reliable. For that reason, I ultimately passed on even reading about manufacturers and brands, as a matter best handled by experts. Not everyone would go this way, of course, and there's nothing obligatory about it; I just considered that, for me in the weeks available, taking the extra time to sift through proprietary information and marketing hype would be a bad investment. (I felt vindicated when my surgeon told me at the end that valve manufacturers are highly competitive--he didn't quite say "cut-throat"; he may have thought the phrase a little insensitive under the circumstances.)
In the end, I kept for myself a single choice, the one that nobody could make for me--the informed choice of what risks to incur and what trade-offs to make. My initial goal in studying had been to identify reasonable options, and I had already concluded that either mechanical valve or xenograft was a responsible choice. Now I assessed the relevant factors--the greatest being medication vs. re-operation--in light of my personal comfort with them and their effect on my health and lifestyle. I knew my preference, subject to vetting by my doctors, but another could reasonably weigh the same factors and make a different choice.
It meant a lot to me that I was going into surgery knowing that I had made the best choice I could in the situation, and that my doctors understood and were on board with my choice. Of course, the final returns are not in. We all know that there is great variability in individual outcomes. But I am comfortable that I made the best choice I could, for me, with the knowledge available at the time. And that matters to me.
