here's the thing, I normally have you on my ignore list because you are not a person who appears to be interested in any other view than your own. You know it all and are apparently here to tell us why we're wrong. You don't engage in genuine discussion. Further I don't believe you are genuinely interested in listening or prepared change you mind.
However for the sake of testing if I'm wrong lets have a look at the points you raise.
Firstly I'd like to say it would be nice if instead of throwing down a gauntlet you could speak (write) in a civil and polite manner. That in itself makes me disinclined to discuss things with you.
or did you mean 4?
#1 You have claimed in the past that getting 15 years from a tissue valve makes one a statistical outlier.
If this is the case, is 60% of an outlier a relevant argument?
it strongly depends on the age at operation. I have not seen any evidence to show that a person operated on at (say) 38 will get 15 years from a tissue valve.
This retrospective cohort analysis quantifies survival and major morbidity in patients aged 50 to 69 years receiving bioprosthetic vs mechanical aortic valve replacement.
The 15-year cumulative incidence of reoperation was higher in the bioprosthesis group (12.1% [95% CI, 8.8%-15.4%] vs 6.9% [95% CI, 4.2%-9.6%]; hazard ratio, 0.52 [95% CI, 0.36-0.75]).
and from this study
Abstract. Objectives: Reoperation is a relatively common event in patients with prosthetic heart valves, but its actual occurrence can vary widely from one pati
Fifteen-year actual freedom from all-cause reoperation was 94.1% for aortic mechanical valves, 61.4% for aortic bioprosthetic valves, 94.8% for mitral mechanical valves, and 63.3% for mitral bioprosthetic valves.
So "all causes" did not specify how many aortica mech valves were replaced due to failures of anticoagulation (causing obstructive thrombosis and if those properly followed treatment options with tPA) or aneurysm development. Further this graph suggests its just getting worse if you to past 15 years, and the younger you are the more you'll be anticipating a lifespan exceeding 15 years ...
So its pretty clear.
#2 Do you have any statistics on how many mechanical valvers:
A. Will still have the cognitive ability they have today to self manage anticoagulants (using your spreadsheets, etc.) 15 years into having their valve? How about after 20? Or 30?
why wouldn't they? And why wouldn't they have a carer who can (actually some of the people I help are carers for people who don't have the ability to manage themselves
B. Will still have the ability to get themselves to an anti-coagulant clinic on a regular basis in 15 years or more if self management fails? What happens when they can no longer self manage or regularly get to a clinic?
seems like a very outlying case ... can you explain who you may mean? Such as a specific example case?
C. Will NOT develop another condition (arthritis, cancer, strokes, ulcers, etc, etc, etc.) whose treatment will be negatively affected by or impossible to implement due to anticoagulants used for their mechanical valve in 15 years? 20? 30?
well the vast majority of common or anticipable conditions are indeed manageable with ACT ... can you suggest which ones can not?
What about Cancer? As far as I know its a high probability that your tissue prosthetic valve will be badly damaged by chemo (shredded was the word a patient I know was told) which is not the case for a mechanical valve.
So, I've diligently and conscientiously answered you demands for answers. I hope you find worthwhile avenues for investigation with the data presented here. Remember: these are in large NOT my opinion. They are research data.