aortic valve replacment

I will be having surgery in about a month to replace my bicuspid arotic valve. My condition has been known since I was a baby. I am 25 now. Recently, I went to three different cardiologists to get an opinion on whether surgery was necessary, and each had a different opinion. One said I should have the Ross procedure, the second said I should just take medication and delay surgery, and the third recommeded a tissue or mechanical valve replacement. I have come to terms with the fact I need surgery, and am leaning toward a mechanical valve so I don't need surgery again. My first question is: 1) Is it common for three cardiologists (who are well-known and respected) to have such different opinions? How is a patient supposed to trust one doctor, if the next has a totally different way of handling the situation? 2) the doctor who said I should have the Ross Procedure didn't even tell me about a straight aortic replacement. Aren't doctors supposed to lay out all the options for you, then give their recommendation? 3) This doctor also said the reason she thought I should have the Ross is so I didn't have to take blood thinners. But, if I get a tissue valve I'm facing multiple surgeries over the course of my life. Isn't heart surgery such a massive trauma to the body that doing it gets riskier each time? 4) I know if I get a mechanical valve, I will have to take coumadin forever. I know I will not be able to do contact sports, but are there any side effects over the long term? (ie sexual, physical, psychological?) Is there any reseach done on patients who have taken it for 30, 40, 50 years? Is there anyone reading this who is young (or was young) and taking coumadin now? What is your experience? Sorry this is so long. I really appreciate any response.

[Cleveland Clinic, MD]

Dear david,

Thank you for your question. There are two main options for aortic valve replacement: mechanical and tissue.  Examples of mechanical valves are St.Jude, Star-Edwards and Medtronic-Hall.  The advantage of the mechanical valve is its long life (usually longer than the person receiving it).  The disadvantage is the need for life-long coumadin. There are no long term complications from taking coumadin other than the bleeding risks.

Tissue valves are made from pig or cow hearts and last about 5- 10 years.  The main advantage is not having to take coumadin.  Aortic homografts are tissue valves from cadavers and also do not require anticoagulation and may last longer than other types of tissue valves.  No one really knows how long but it is probably more than 10 - 15 years.  The chief disadvantage of the homograft is availability.  

The Ross procedure transplants the patients own pulmonic valve to the aortic position and places a tissue valve in the pulmonic position.  We have stopped doing this procedure at the Cleveland Clinic due to poor long-term outcomes with the pulmonic valve.

As you can see each option has its pros and cons.  Ultimately the choice is between you and your doctor.