first case of amputation due to non compliance with an on x aortic valve

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From the publication:
.........if the patient is not going to be serious about the need to continue taking warfarin, probably best to stick a tissue valve in them, regardless of age.

I certainly agree that if you are not serious about managing Warfarin and INR do not go on Warfarin. Many years ago, 1974, I suffered my one and only stroke while on Warfarin. The stroke was not because I knowingly mismanaged Warfarin......but it was due to not understanding the true importance of taking the drug as prescribed......and I became 50% blind and that blindness is with me to this day.

A few years ago I visited OHS patients in one of our local hospitals after they had had their surgery. I noticed that several young men in their twenties with endocarditis(?) were impanated with tissue valves. I asked the nursing staff why they were implanting tissue valves instead of mechanical valves in such young men. The answer was "they are drug addicts and can't be trusted to take Warfarin in a prescribed we put the tissue valves in to preclude the need for an anticoagulant":cry:.
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I believe I understand how you feel.
Yes, most should, so as to avoid repeat surgeries. But,
To me it depends on the nature and reason for the VR. If its Bicuspid Aortic Valve (BAV) then if the surgery is done young then to me this makes a case that aneurysm is probably going to be a driver of the next surgery, of course we can't predict the timing of that. In my case an aneurysm drove reoperation (valve would have lasted longer) and that occured in my late 40's

For someone who is going to have a series of operations in their future (as one who most likely will be with BAV and having first surgery before 20) serious planning and serious engagement needs to be had with the patient.

Presently I feel this isn't done much (based on here) but I believe it was in my case as I had many meetings with my surgeon and knew that it was a lifetime thing. Of course as a late teenager and early twenty year old I had my own ways of thinking about this; but I did know my limits.

As my surgeon said to me in the early 90's "we don't want to get you on warfarin just yet" and that delay proved helpful because back then there were no Roche Coaguchek portable systems for INR monitoring.

I believe I got into mechanical at about the best time in history.
Like the nurse who confiscated my razor in the hospital and told me that now that I'm on warfarin I can't shave with a razor anymore, as I might bleed to death if I cut myself. I did not listen to her and had my wife smuggle me a razor in the hospital. And, I have continued to shave since then as well and I even cut myself once. I'm happy to report that I did not bleed to death, nor did I bleed to death when I cut my leg while gardening or when I recently bit my tongue.
Chuck: i hear and know what you'r saying is oh so true, people are worrying about bleeding to death from what, a paper cut or something? for years though i had the same concern, and I should not have done so, live and learn. well, what happened to me was this. I was at work and slipped and fell, and yes, cut myself with a sharp knife that I had in my hand, well I didnt need stitches or anything but it was a pretty bad cut. I held it with pressure for as long as I could, and it stopped. And I am still alive to tell others of my story. I am saddened to hear what happened to this young lady, and had real bad problems. very sad!