It's great to have options

With three cardiac surgeons and a cardiologist each recommending surgery this year, it's pretty obvious that while surgery in 2008 is technically an option, it's the only option that makes sense. But what is an option for me, fortunately, is the type of valve with which my surgeon will replace my aortic valve. Who would've guessed there'd be options here? I'll give the quick rundown, for those of you who are interested.

One option is a mechanical valve, which is a man-made valve that is built to last a lifetime (and then some). The big negative here is the necessity for a lifelong blood thinning medication, coumadin. With a blood thinner the annual risks of uncontrolled bleeding and stroke total about 4%, and considering I intend to be around for at least another 40 years, the math just doesn't sound good to me. Plus while the valve itself doesn't wear out, there's a chance tissue could grow around it such that it interferes with the valve operation, a resurgery would be necessary. And last, the constant "ticking" noise might drive me crazy (or more crazy, as the case may be).

Another option is a valve made from pig or cow tissue plus some plastic. While these don't always carry the burden of lifelong medication, the big problem here is that these valves wear out, especially for younger people. So for me we'd be talking a valve at age 42 (this year), ~52, ~64, and ~80 years of age -- possibly 4 valve replacement surgeries in my lifetime. Ouch. And not to mention that as these valves wear out you go through the same phases of not feeling well, having reduced physical abilities, and deciding when is the right time for surgery, which of course you realize, is never.

A relatively new option is a "freestyle" valve, which again is pig tissue but is a replacement for the valve and the aortic root (the base of the aorta that attaches to the heart) as a single unit. While this valve and root unit perform together "as God intended", replacing it down the road is a big unknown -- too few replacements have been done worldwide to have good outcome stats, and surgeons that have done it have realized it's a particularly delicate procedure. Oh, and it's not a forgone conclusion that my root needs replacing anyhow.

The final option, and the one I'm going with as my first choice, is something called the Ross procedure. With this procedure, my surgeon will replace my aortic valve with my pulmonary valve. Because this replacement valve is my own tissue, this means there's no rejection, it performs wonderfully so my heart will keep up with all my sporting intentions, and if all goes well it will last forever. There is, however, the issue of replacing my pulmonary valve. This is done with a donated human valve, something that works pretty well for pulmonary valves but not for aortic valves. Unlike the 100% chance of resurgery in 20 years on a pig or cow tissue aortic valve, the chance here for resurgery is about 30% in 30 years. That I can deal with. The negatives? The Ross procedure, which takes me from being a "one valve patient" to being a "two valve patient", is delicate and requires a longer surgery.

Certainly my options could change at the time of surgery, if things aren't as everyone has guessed, and the tests have indicated, thus far. But thus far, options are good -- I can go in with a plan A and B and hope for the best.