You’re right — what I said was an oversimplification and a little bit untrue. I agree fitness and Compton dotier are a huge factor in selection of valve type.

You’re right — what I said was an oversimplification and a little bit untrue. I agree fitness and Compton dotier are a huge factor in selection of valve type. That said, in my experience, cardiologists are really hesitant to use a tissue valve in someone under 50, especially if it is an open heart procedure. With an open heart, the adhesions (scar tissue) on a revision surgery makes it far riskier and less likely to heal well. So the follow up for a valve replacement after 10-20 years becomes much more high risk. Not a problem if they’re 70 and they would be 90 at the time a replacement is needed. Much more of a problem if they’re 30 and will likely need 4-5 artificial valves in their lifetime. The new thing is to first do a TAVR/TPVR, which involves cutting into an artery - most commonly the leg - and placing a valve by routing it through the artery into the heart. But, any revision will need to be an open heart procedure. So the first replacement is trans catheter, then the second is open heart. Thus, the third replacement gets much more risky. So, if someone is 50, the second replacement is at 65, and the third would be at 85, so not a huge issue. By contrast, if they’re 30, the high risk 3rd surgery will happen at 65.