Two AV ops-Which first?

Imminent replacement of AV creates a quandary.  Which prosthetic valve to choose first? Ruling out mechanical valves, leaves human tissue valve and C-E Bovine pericardial valves (or similar) as options. Is there any advantage in choosing the Homograft first and then further out, when it degrades, replaced with another homograft or C-E?  Or vice versa: more conservative approach now with C-E first, and then Homograft for second operation, 5-12-15 years out when I will be 62-77?  

Can two homografts be done at all?

[CCF CARDIO MD - DLB]

I favor using a homograft in patients who are reasonably young, in patients who are candidates for this type of procedure. When it ultimately fails (hopefully after several years) repeat surgery with homograft, tissue valve or mechanical valve are all still options.