The details on the valves are interesting to me, though they may be a bit information-rich for some folks. Here's the choice: I could opt for either a carbon-titanium artificial valve, or a polyester-silicone-cobalt-chromium-cow valve. Both are manufactured, but the second one has the valve portion made of pericardial tissue from a cow. It's not the actual heart valve, but similar, and more durable for the long run. This is known in short as a biological or bovine valve, but obviously there is plenty that is not biological.
Some of you may ask, I've heard about pig valves? Apparently pig valves are not used as much anymore. Pigs do have hearts that are similar to human hearts, so the valves from pigs were used as replacements in humans, but my best understanding is that they didn't last as long as the new bovine/cow valves.
The advantage of the artificial carbon-titanium valve is that is never wears out. That seems like a logical choice, because having the surgery once is bad enough. However, the artificial valve has a tendency to bruise red blood cells, and that creates a tendency for blood clots, and blood clots are not good at all. To combat that, artificial valves require a lifetime regimen of coumadin, or warfarin, which is a drug that helps prevent blood clotting. Warfarin takes some monitoring to keep the right dosage, and also causes some challenges for certain foods such as kale, brussels sprouts, dark greens, and cranberries, among others. And I like all of those, especially cranberries!
The other challenge with warfarin therapy is that there is an ongoing 1-2% annual chance of an "event" that causes neurological damage or worse. That is not something that sounds good to me, since over 15-20 years those small percentages start to add up.
The bovine biological valve doesn't require warfarin, but it also may wear out over time. What that means is hard to say, because the data we have now is from pig valves that were done 10-20 years ago, or more recent data from bovine valves. In short, there is a high chance of having another surgery to replace this valve in, say, 15 or 20 years. But much can happen between now and 2037, so I am opting for the bovine biological valve.
It feels very strange to me to try to decide between two options that have different, but negative, long term possibilities. Most of the time, I know we don't get to choose, so I suppose that is a blessing. Both the warfarin therapy and the valve replacement therapies could change a great deal in the next decade or two, so that adds to the uncertainty. For me, the best choice is to avoid the warfarin if I can, get the best biological valve available, and hope for great progress in cardiac surgery options for the future.
Thanks for reading!