Yes at my age I am thinking that if I go with tissue I could be looking at 2 OHS and one TAVR and maybe even in that order because doing a 2nd OHS at a younger age would most likely be a good move. No perfect answers here but I do appreciate your insight.Freebird - I'm not going to tell you mechanical versus tissue -- but at 58, the likelihood that you'll need a procedure to replace a failed/failing tissue valve in your lifetime is fairly high -- depending on how much longer you live, and other factors. The likelihood that you'll have to replace a mechanical valve are negligible -- I won't say that mechanical valves aren't sometimes replaced, but the track record for mechanicals is exceptional.
If you're going mechanical to avoid the clicking (which you get used to) or having to manage warfarin - realize that warfarin isn't that big a deal. I've been taking it for 28 years, and many on this forum have been using it much longer. It isn't really a big deal.
If you're gambling that by the time your tissue valve needs to be replaced, a new technology will have been developed that can be done through a catheter - realize that this is still a gamble. Perhaps they'll have an improved TAVI procedure and valves, perhaps they won't.
By that time, maybe they'll have developed an anticoagulant that doesn't require dosage adjustment and weekly testing. Maybe they won't.
Maybe, by the time your tissue valve fails (all of this assumes that you'll be around long enough for it to fail), they'll have a better mechanical that doesn't require anticoagulation.
This is all a bunch of 'perhaps' and 'maybes.' What should be fairly obvious is that, at 58, a tissue valve may not make it without having to be repaired or replaced at some time in your life. Second (or later) surgeries are always more complicated than the first - scar tissue to deal with, adhesions, and other stuff make it more difficult for the surgeons.
I'm sure that you've thought very carefully about this -- but, if you're avoiding mechanical because you want to avoid warfarin, please think again. (One more thing -- there are other reasons that people take warfarin - if you develop one of the other reasons, you may wind up taking it anyway).
Thanks for your thoughts. I have a congenital bicuspid aortic valve. They are checking my echo every 6 months. I am in "severe stenosis" but apparently the echo shows that it hasn't damaged my heart yet and I don't have symptoms. My cardiologist suggested I meet with a surgeon and I met with two. The most well known/respected one is the one I'll be going with. His opinion was that I could get it done now or I could wait for symptoms. Thus I'm in that mode currently. My next echo is in March. If I still don't have symptoms then, but the echo shows a worsening, then I'm sure my cardiologist will say it's time.Are you saying you went 20 years in the state of severe stenosis, just watching it periodically on echos? Watchful waiting is what those of us with stenosis of the birth valve do. Not sure what you mean by "severe," but that usually means it's time for replacement. They do not wait for symptoms. As Pellicle indicated, the change due to stenosis is not linear when it gets bad. It can change quickly. That's why it's echos every 5 years, every 3 years, every year and then 6 months. My stenosis was due to a bicuspid valve. I never made it past the every year and only had my first "symptom" after being told "get thee to a surgeon" based upon the echo.
What was the thing that made you determine to have surgery? My cardiologist told me it was time to schedule surgery. I asked him when should I have it, next week or in a few months? He said "best get it done within less than three months, you don't want to suffer the syndrome known as sudden death." That kind of focuses you. I saw the surgeon a few weeks later and he said "soon". I got it done in a little more than a month from seeing the surgeon. After removal, my surgeon said my AV was severely clogged and ready to quit.
I had mine done at 55yo. I chose mechanical because I'd had surgery 3 times before, now 5 times total. No surgery is a pleasant process and they all have risks. I've never had an operation that has been 100% successful, there's always something. The good thing is it's usually not too big of a deal, but I've had pain from my first surgery 25 years ago every day. I just don't touch that part of my body By the way, the metric for success for OHS is life, not quality of life. Take the statistics with a grain of salt.