Separate from that is at 58, (and second time around), does one go bioprosthetic again with the chance of needing another surgery in my lifetime ? Apparently , I am an unlikely candidate for TAVR due to the size of the valve unless things change.
ok, I'll have a go at grappling with this.
On the subject of needing another surgery, I would also ask the perhaps unthinkable question of the word used in cancer treatments which is remission. I have a few friends who have had serial remissions with as much as several years in remission. Each has had the view that every day free is a good one. But its not the word "cure". So each is clear that one day they may find its returned. They are not concerned by this (we've had long discussions) although their partners aren't in the same situation (mostly).
So this is to say "if you can, consider to encompass that in your planning"
I come back to the view that mechanical prosthetic valves are managed by managing ACTherapy while bioprosthetic valves are managed surgically by replacement. We are used to replacing things which wear out, but we seem to no longer be able to grasp the idea that something will last my life time if I tend to it, like the Lavender that my cousin gave me (and I planted in my garden) when I moved into this house. This house was built in the 1920's and many have lived here before. Some have tended it, as do I. Barring a fire I am of the view it will be in "my estate" (when I pass).
My personal definition of a realist is one who reacts to issues of reality and deals with them using reality. Indeed my personal definition of sanity is "minimal distortion of reality", meaning that concocting fictions that ease the mind to allow comfortable living is a sign of insanity or at least mental infirmity. To do otherwise is not "coming to terms with something" it is (to me) "attempting to change the terms by pretending they are something else".
Not everyone will like my view (or even follow it) but it has stead me in good stead in my life and in the effective evaluation of others.
A person here once remarked that "
what makes a good valve is a valve that gets you 20 years" .. I anticipate that like Dick my valve will not require replacement again. All I have to do in the meantime is to manage it (and myself). At my surgical meeting it was clarified to me that a mech valve would last my life, but that a tissue would require a reoperation at some point in my future. I didn't want to put my wife through that and I didn't want to have a 4th surgery which may save me from death (or as I view it, re-negotiate the inevitable date) but at the cost of a very high likelihood of a drastic reduction in my health (because 4th surgeries and longer surgery at a time when one can least recover from such things ).
At that time I knew nothing about ACT but as always I believed that I can manage reality or adapt to it. As it happens I've learned a lot about ACT and managed ACT very well (for myself and for others).
From the day that you chose your valve you must have been clear that it would not last you out. So now you have reached that day. I say "look carefully at the options" and set aside emotional views. Look carefully and decide from the position of knowledge and experience.
This is not to say that ACTherapy is without issue (cite: Harriet) but as long as you know you are not "intolerant" then in all cases I am aware of it can be managed.
I would not think it wise to add more issues to your life such as a known cardiac surgery in your autumn years, for that to me would (having watched a few) not lead to a "live long and prosper" outcome. Life is different in ones 70's and I've seen quite a few fit old ladies suddenly wither and die from a good hard surgical shove (like a hip replacement gone awry or an accident on the ride on lawnmower).
Live for now, but don't forget to plan for tomorrow.
Best Wishes
