I'm not a doctor, so these are talking points for you to use when discuss this with your surgeon.
Mitral valves can be repaired more than 90% of the time. Repairs are durable and have better long term outcomes than replacements. So for the mitral valve, consider a repair rather the replacement.
Aortic valves are most commonly replaced, particularly when stenotic. But always worth asking the question. Previous posters mentioned reasons for picking mechanical or for picking tissue.
For most people it's a lifestyle choice. My backup for my mitral valve surgery was tissue because I didn't want to run the risks associated with coumadin. Mechanical valves shred some blood cells when the leaflets slap together as they close. Without coumadin (or another thinner) this would lead to clotting, which in turn leads to, among other things, strokes. The blood thinners are to prevent this and you have to keep taking them day in and day out. So think about how that will be, never running out, always having it with you when you travel, etc. But lots of people manage to do it. The other consideration is that if you start bleeding, it is harder to stop. So, in my case, since I do a fair amount of wilderness travel far from anything, I decided there were a number of risks I didn't want to run. On the other hand, tissue valves are not as durable and need to be replaced. OHS is not much fun and the second time around is tougher than the first according to the statistics.
Eventually less invasive tissue valve replacement surgeries will be available. Not yet, but they will arrive at the larger centers of excellence like USC, Cedars and UCLA here in Los Angeles first.
So, in the end the choice is very personal and depends on you goals, lifestyle, ability to follow a medical discipline, and your view of the future. But as others have said, either choice is better than what you have now, so neither is a bad choice.
Jeff H posted a note for Lance that says:
You are struggling with the same question that we all had to struggle with - you are not alone. At the time of surgery my surgeon decided he could fix my aortic valve. There was only a small chance that he would be able to fix it - 5%. So, I had to choose between a tissue and mechanical, but it ended up being a moot point. The decision was very hard for me - I agonized over it. I looked at both the Edwards tissue valve and the Onyx mechanical. You should look into the Onyx valve if you are leaning mechanical because they are conducting a study that ends in 2015 that, if successful, may mean you won't need to take coumadin long-term. You would need to take Plavix or another newer drug. In the end I choose a tissue valve for the following reasons:
1) Did not want to be on coumadin for the rest of my life, as the study is not complete.
2) I spoke with many doctors about coumadin use and the complications it can cause later in life - can really cause problems when dealing with other issues that come up as you age.
3) In 10 years when the tissue valve may need to be replaced there will likely be mush less invasive techniques.
Please know this, whatever you decide you will be better off than you are today and it will be a good decision.
If you have not already done so, you should ask your cardiologist and surgeon what they would do if they were in your shoes. Both answered tissue in my case. Your situation may warrant a different answer, but you will find their answers insightful.
I wish you all the best and will pray for wisdom for you to make the best decision for yourself.
Annette posted a note for Lance that says:
I understand there is a technique similar to stents for Aortic valves which originated in Hadassah hospital in Israel. Try finding out if this is an additional option for you. I recall hearing the recovery time is much faster.
I share your dilemma about which type of Mitral Valve surgery to choose for my second surgery. I had a Tricuspid and Mitral Valve repair in Oct., 2012 but was told I will need another Mitral Valve surgery. It is now a question of when and which type of surgery is best.
In my case, I may need surgery in a month or in several years or more ahead. Cardiologists are uncertain.
Deb Ziegler posted a note for Lance that says:
I had my mitral and tricuspid valves repaired at the Cleveland Clinic 18 months ago. My aortic valve is also leaking, but apparently it wasn't bad enough for them to fix or replace....they said it shouldn't cause me any problems down the road.
Being on a blood thinner isn't necessarily bad, it is just something you need to decide if you want to deal with. My advice would be to find a good surgeon who has done many valve surgeries ( more than 100 per year) at a major cardiac center. Adam Pick has compiled a list of top rated valve surgeons, so.look it over and try to find one near you. I would also recommend reading Dave Van Buren's journal on this site. He has done A LOT of research on risk and goes through it all on his journal. Be sure to start with the first entry. Once you find a surgeon you are confident and comfortable with, ask as many questions as you can think of. Being an informed patient will be helpful throughout your journey.
Deb Ziegler posted a note for Lance that says:
Getting your valves repaired is better than getting them replaced.......fewer complications, and repairs last longer. However, it is not always possible to get them repaired. Sometimes the valves are too diseased to repair so they need to be replaced with either a tissue valve (cow or pig) or a mechanical valve. Mechanical valves require you to be on blood thinners forever, but the valve should last the rest of your life. Tissue valves don't require blood thinners, but they tend to wear out after ten to fifteen years, and then you will have to have another surgery to replace it again. Mitral valves are generally easier to repair than aortic valves. Your surgeon will decide if it is repairable after he sees it, so you will have to let him know what kind of valve you want (tissue or mechanical) before your surgery in case he has to replace it.
Brian Reid posted a note for Lance that says:
Hi Lance. I had mitral valve repair at U of M by Steven Bolling on April 16th of this year. Recovery has been great. My best advice on trying to decide who to pick to care for you are to read reviews on each Doctor and their experience on what you need to have done specifically. Secondly, after meeting them choose the one you feel most comfortable with. When I met Dr. Bolling after going to 2 other top surgeons I instantly knew he was the one by the confidence he exhibited in his work. Best of luck in your journey.