selecting the type of valve replacement

[Robert S]

I am a 59 year old male with Aortic Stenosis first diagnosed in 1975 & monitored ever since.  As part of my annual physical this year, I had an updated echo run to check the progress.  My valve is now very restricted and I was informed that it is now time to replace the valve.  My doctor is suggesting the St. Jude valve.  I noted that last year, only 19% of the AVR's at the Cleveland Clinic were mechanical ones.  I am not happy about the lifetime on blood thinners.  I also have frequent nose bleeds.  Two years ago I needed to have a cauterization in emergency for a particularly bad one.  Almost every morning, when I clear my nose, there is some coagulated blood expelled.  If I am on blood thinners this could really become a serious problem.
Please give me more information regarding the very high proportion of tissue valves vs. mechanical ones at your clinic.  What are the reasons behind this?  Your stats do not seem to indicate that high a proportion of patients over 65.
Also please comment on the problem I have with frequent minor nose bleeds & how that would likely play out with blood thinners.

I am in excellent health, in good physical condition, take no medications at all.

Thank you

[kd re: longstanding MR]

How is your blood pressure?  When my BP is up, I have a "bloody nose" constantly.  The vessels inside my nose seem sensitive to it and, while there is no bloody flow, the blood is always there.  Just a thought.  I had the problem for years before I was put on BP meds.  Now, I can always tell when my BP (I have high isolated systolic bp.) is up just by my nose.

[CCF-M.D.-CRC]

Dear robert,
I think our numbers reflect a combination of surgeons prefrences and patient's choice.  There are pros and cons to mechanical and tissue valves so ultimately it is very much a personal choice.  Given your frequent nose bleeds this may be a reason to prefer a tissue valve.  On the other hand you are young enough that a tissue valve may need to be replaced whereas a mechanical valve probably would not.  

If you would like to be seen here at the Cleveland Clinic I would recommend Dr. Lytle.  This would give you a full range of options for valves.  You can make an appointment to be seen here by calling 1-800-CCF-CARE and asking for an appointment with one of the F15 "valve" cardiologists.