Neither the survival nor stroke statistics will really help you make a decision, as they favor neither mechanical nor tissue.
If you are atheletic, you may still qualify for the Ross Procedure, although the line is hedgingly drawn at 50 years old on the Ross Registration site. There are studies that say that it can be successfully performed at 70, so someone is out there doing it.
Otherwise, the decision has more to do with lifestyle and personality.
At our age, based on the "If All Goes Well..." scenario, the choice is between taking the issues, monitoring, and dangers (smaller, but real) of Coumadin on a daily basis; or relative freedom for about eighteen years, followed by monitoring, then the risks of surgery at about twenty years, followed by relative freedom for the remainder of your life.
Basically, will you handle your risk in smaller, relatively continuous pieces, or in one, big lump? It's a lot like the lottery: Cash or Annuity?
I am delighted with my Mosaic tissue valve (porcine), and the freedom it has given me. There are others here with the Perimount Magna (bovine), who are equally pleased. I did not find surgery so bad that I would be willing to deal with the risks of anticoagulation therapy every day to avoid it. To me, the surgery is a very small window of time looking out onto many years of life.
Others here are delighted with their mechanicals, and fully feel that whatever they have had to deal with regarding Coumadin is a small price for avoiding the future surgery.
I suggest you read the Coumadin forums to gain a feel for some of the benefits, constraints, risks, and regular monitoring requirements of warfarin.
An aortic homograft will last 20-25 years, which now places it within the range of the other tissue valves, which have been further improved over the last year. The difference with homografts seems to be more evident in younger recipients, who calcify their xenograft models faster. As such, I have lumped it into tissue valves for our age group.
Best wishes,
