I think that it's very important to consider your likelihood for later surgeries, particularly in conjunction with any health issues you already have or see a likelihood of having. If aneurysms are in your family, it's a consideration in my view.
- The activity level of you or your children (unless you are personally into contact sports, or activities that are prone to creating head trauma)) is pretty much immaterial. Coumadin wouldn't keep you from any of that. The most dangerous types of bleeds that are most associated with warfarin would be intestinal bleeds, delayed post-surgical bleeds, and ruptured blood vessels in the brain. Bumps, bruises, and superficial cuts may be more visible, but only for some users, and just don't represent a special danger for the vast bulk of mechanical users.
- The fact that you bruise easily might indicate a consideration. You could find out by having tests to determine if your blood has other clotting issues that might be worsened by warfarin. or if you have overly fragile blood vessels. Liikely not, as even taking The Pill can cause that, but it's worth consideration.
- It is extremely unlikely that you would get 20 years even from the newest tissue valves at your age. If you chose and stuck with tissue, the likelihood is that you would have a minimum of two, and more likely three further surgeries. The last one or two might be through transcatheter placement, but the first two would likely be standard surgery (my guess/estimation of the medical industry's readiness). I just had my second AVR five days ago. It isn't/wasn't fun, but it's doable. I did go with a tissue valve again.
- Coumadin complicates later surgeries. Bridging is one of the specific points at which stroke - or bleeding - danger is higher than usual. Surgeries can be done (such as hip surgeries, replacement of other valves, or repair of aneurysms), but doctors will put it off longer and it will carry a higher risk load, and some surgeons just won't touch you, maybe limiting your choices.
- The overall history seems to be that neither choice will affect your longevity after the surgery by any appreciable amount, so that's hard to weigh in. The risks largely counterbalance each other.
- There's certainly nothing wrong with a mechanical valve for most people. They are excellent valves and pretty much don't go bad - ever. I would opt for the On-X that Al Capshaw likes to point to, as there is a possibility still of aspirin-only ACT (AntiCoagulation Therapy). The trials have been going for some time, and haven't been stopped. (They would be stopped if there was reason to believe the death rate was unacceptable.) It's worth it, just on the chance that it's approved. Other than that, all of the leading mechanical valves are excellent. The On-X also has the protection against pannus (scar tissue that can grow quickly or very slowly at the operation site, or even creep up onto the valve itself), which is one of the more common reasons for removal of a mechanical valve when it does become required.
Best wishes,
