[myrloc]

> The surgeon told me I was too young to have a bioprosthetic valve – from a pig or a cow – as these don’t last like metal ones do, and other surgical options, even though they wouldn’t need warfarin for ever were not recommended for me, as a relatively young patient.

I had my pulmonary valve replaced when I was 13 with a porcine (pig) valve. True, they don’t last forever, but they can last a good two decades before you need to exchange one out. My cardiologist, as far as I know, plans to use another one for my next surgery.

[Supermancho]

I have had a synthetic (metal/plastic) aortic heart valve for decades. The differences in anatomic valves and the designs do matter, day to day. My organic was replaced at 2 with a near-experimental synthetic, then at 9 with a Bjork-Shiley design (blood thinner from then on) then again at 32 with an Onyx design.

My heart is now considered too damaged to get a more modern version, even if there was a big improvement (unlikely). The flow control and stress testing that has been done on synthetics make them far superior to organics, among other features like the multi-leaf design that makes blood thinners a formality via FDA blanket process rules for synthetic approval.

I'm really surprised that anyone recommends organics for aortas or even chooses to have them. To continue the rather opulent lifestyles that celebrities/politicians might maintain, there may be a narcissistic belief they can stave off the inevitable growing handful of pills they need to take every day to soldier on. Good luck to each and every one.

[strangattractor]

It is related to age. If your immune system is on the decline as it generally is as we age it doesn't do as much damage to the bioprosthetic valves and they last much longer. The controversy revolves around just what that age is. When my surgery was done I was in that gray zone 59. The first surgeon I spoke with was adamant about using the mechanical valve. The next surgeon I spoke with was more like I can see arguments both ways.

I am fairly active. I chose the bio because I knew I would have trouble regulating the thinners. The tissue is chemically treated in the newer valves to increase their life span (maybe). When I get this valve replaced they can insert the new valve within the old using TAVR which doesn't require them to open your chest. If my valve last long enough I figure they will have new better ones using carbon synthetics.[1]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9967268/