Inspiris Resilia vs On-x, can't decide

Groy · May 24, 2023

LoveMyBraveHeart said:
Hi Groy, and welcome!

If you go back through my previous posts, you'll find my husband's story. He went with the Inspiris Reslia and promptly had it replaced 10 months later. I'll spare you the details because it was a bit of a rollercoaster and not the typical experience with that valve, but he ultimately ended up with the On-X.

His last surgery was August 9th, 2019 and he's doing great. He's been opened up a few times now, and has lived to tell the tale! Warfarin is no biggie (I think the only people that make it a big deal are those that aren't on it), self-testing is no biggie (once we got everyone to respect his wishes of a 2.0-3.0 INR range...that was an epic battle spanning years. Ridiculous.), and he's still just as active as he was going in. Still rides his dirtbike, captains our little boat, drinks alcohol, uses cannabis, works a physical job, we are DIYing a complete gut and remodel on our house, he still does heavy lifting...nothing is different for him except the scar, the warfarin, and the fact that we keep a special first aid kit for him for when he gets bumped, bruised, and scratched. Which has still definitely happened just as much as in the past! He's a stubborn guy with the will to do just about anything

All this is to say, I guess, that we can go into these things with an amazing support system, all of our t's crossed and i's dotted, thinking we have all of the ducks in a row, and yet things can still turn upside down on us. Which is not to scare you, but to encourage you that many of these fine folks here have had plans go arwy and have lived lives after, just as full as before. You are in the right place, and doing your due diligence to research for yourself and make an informed decisions, which is the best thing you can do. Keep asking questions, and keep hanging around! This is a good group of people to help you through this.

All the best to you!
Jill (wife to Mathias, OHS 3x over 10 months).

Oh! I should edit to add, Mathias had AVR and ascending aortic aneurysm fixed at 25 years old. The aneurysm fix is still holding strong from his first surgery, and his last surgery placed the On-X in the aortic position. He just got his yearly echo results back last week "Everything is pumping along just fine!" per his new cardio. Even a couple of years later and we still celebrate when his echo comes back peachy.

Hi LoveMyBraveHeart

Thankyou for sharing your story

Glad Mathias and you are positively surpassing your situation.

The more I read more I incline to a mechanic valve, it seems that those biological valves ruptures more often than it appear, and warfarin does not look to scary anymore.

Mister_James · May 24, 2023

tom in MO said:
I have US blue cross and blue shield and self monitor and self manage. My cardiologist's practice doesn't like it, they want you to go to the coumadin clinic. However my cardiologist allows it, thus his practice allows it as well.

That's correct.
US insurers want to steer you into a monitoring program if they are to cover self testing. The monitoring group will provide a meter on rent and supplies as you need.
They don't manage your testing but you will not call the doctor with your results.
The other choice is to pay out of pocket for supplies and meter and have an understanding with your doc.

Mister_James · May 24, 2023

Let me add even testing strips cannot be picked up at your neighborhood pharmacy.

pellicle · May 24, 2023

Groy said:
I’ll probably go with On-x and will do my best to take care of me and my new valve hoping no reintervention

while you're thinking about that:

consider "claims" vs "measurements

https://www.valvereplacement.org/threads/aortic-valve-choices.887840/page-2#post-902334
and if you were steering towards the On-X because of some perception of lower INR being any sort of meaningful parameter:
https://www.valvereplacement.org/threads/second-surgery-20-years-later.889104/post-924688
PS: the good thing about taking your time is you can swing back and forward between leaning towards one valve or another only to have a third option you hadn't thought of emerge ;-)

pellicle · May 24, 2023

Mister_James said:
The other choice is to pay out of pocket for supplies and meter and have an understanding with your doc.

I suspect that's actually cheaper in the long run...

pellicle · May 24, 2023

Mister_James said:
Let me add even testing strips cannot be picked up at your neighborhood pharmacy.

good point, but I've been buying online (as many others have here who are from the USA) and its a lot cheaper. This is where I buy from, of course its AU$.

In Australia I could buy from the local pharmacy (because its not a prescription item, that's for drugs) but the cost is high ... last I priced it it was more for a 6 strip tube than I pay for a 24 strip tube.

But its there at least.

Dano64 · May 25, 2023

Groy said:
I appreciate your best wishes and info, Thank you.

an ascending aortic aneurysm was something I was not aware of.

May I ask, your ascending aortic aneurysm was discovered at the time of the homograft valve surgery? Or time after the surgery? or you developed that aneurysm time after the first surgery?.

My cardiologist never mentioned it until 2018 when the echo tech noticed it. They were not even checking it for many years, so it scared the **** out of me because my cardiologist sounded so shocked. I had no symptoms at all. I was monitored by the surgeon for 3.5 years until it grew to 5.1 cm and I was told it was time. Then I did some research that described the connection between BAV's and aneurysms. It had to have developed after the first surgery in 2001 because it was not mentioned to me by anyone until 2018. My homograft would have kept going but for the aneurysm.

user 15848 · May 25, 2023

Groy said:
Inspiris Resilia vs On-x, can't decide.

Hello

Looking further, for your opinions and thoughts, hopping not to be too redundant.

im a man and 45 years old with a bicuspid aortic valve, but with a healthy heart (except the aortic valve of course) which is pumping blood at good quantities but at high pressure (believe it’s called vertex), severe stenosis and regurgitation, I'm healthy from everything else.

My doctor told me that it’s time for surgery.

He offers me minimal invasive surgery; but he gives me two options... that’s On-X and Inspiris Resilia.

With On-X I'm scared to be too vulnerable to an accident or that warfarin may damage my body/organs at a long run.

With Inspiris Resilia I'm dismayed of how bad could be my second surgery (even with valve on valve tech), or how common this valve will fail at really early stages (1 to 3 years)?

Could I hope that advances in medicine offer me better options, not available today, for a second surgery 20 years from now?

My surgeon says my heart will be at 100% after the surgery regardless of the chosen valve.

And I like lifting weights at the gym.

I'll highly appreciate your opinions, experience or expertise.

Thank you.

Hi, if you are Ok with having a second and maybe a third O.P.S, then i would go tissue,
if you want to get this done and out of your way for good, they i would go OnX

I had same case as you, bicuspid valve, the rest just fine.

Those were my thoughts when i choose in 2015 at 62@age, My surgeon
gave me same option: 1-Tissue and come back here on your high 70s,
2- Onx and off you go, do not see me again.

I have punched a bag or two, no falls or accidents no consequences,

The OnX vendor claims that INR between 1.5 and 2.0 is OK, but i try to keep
it at 2.0, and it jumps at times from 1.8 to 2.3, no matter, no problems,
just forget about it.

INR is something you learn to manage with a home test machine; $500 or less and the test strips about $6 a week

You can almost , eat 99% of everything u eat now,

For me, as per my Cardiologist/Surgeon, The NO , NO, are Grafefruit, Tummeric Extract, and another couple of herbs, because they work with your liver and the warfarin and things can have they own mind and act in an umpredictable way

There is no right or wrong;

But if having more ops in the future , for sure 1 maybe 2 more, is not a concern
then Tissue is what i would do, but i did not .

That is my opinion, and is just that; no rights or wrong here.

pellicle · May 25, 2023

Dano64 said:
My cardiologist never mentioned it until 2018 when the echo tech noticed it. They were not even checking it for many years, so it scared the **** out of me because my cardiologist sounded so shocked.

as I was reading along there I thought that "maybe they don't say anything because they don't want to worry you" ... then you clarified that it was my initial thought "probably they just don't know this and don't keep up with this". This again makes this place a very valuable adjunct to "your doctors opinion" because in some cases and on some topics we do know more than them.

Dano64 · May 26, 2023

pellicle said:
as I was reading along there I thought that "maybe they don't say anything because they don't want to worry you" ... then you clarified that it was my initial thought "probably they just don't know this and don't keep up with this". This again makes this place a very valuable adjunct to "your doctors opinion" because in some cases and on some topics we do know more than them.

My then cardiologist is now retired, so I don't think they were following along at all. He sounded very nervous when he first informed of the aneurysm. I had the echo test every other year and the valve looked good and I kept getting a thumbs up, see you later. I think he was just coasting. Kind of scary when all he handles is the heart.

Mister_James · May 27, 2023

pellicle said:
I suspect that's actually cheaper in the long run...

In the long run we are all dead.

US is very good at hiding health costs. You pay $45-$70 per paycheck for your company insurance.

So these folks send your a meter and strips and your deductible and sat its $100 for the year.

Your doctor sends you a bill for your insurance deductible and it's $35.

While the true cost for the year may be $1,500. You only know of your $135.

Next year your insurance moves from say $50 to $55 per paycheck. You don't think +20% You say duh $5...won't even get me popcorn at the movie theater

pellicle · May 27, 2023

Mister_James said:
In the long run we are all dead.

true ... but between now and then, and over the next 10 years ...

I pay $7 a week out of pocked doing it my way and I'm willing to bet that my health insurance costs are competitive too.

newarrior · Aug 7, 2023

Chuck C said:
Welcome to the forum.

A lot of us have faced the same choice that you now have before you. I was 53 when my bicuspid aortic valve was replaced. Originally, I planned to go with the Resilia valve, but after a good deal of due diligence and several consultations, I ultimately decided to go with a mechanical valve. I wanted to be one and done, and at 53, I was assured of future procedures down the road if I went with a tissue valve. Two of the leading valve surgeons in the country told me the same thing, that at the young age of 53, I should expect a tissue valve to last about 10 years. Some get lucky and it lasts a few years longer. Some get unlucky and it lasts a lot less than that, but on average to expect about 10 years.

So, doing the math, at 53 it did not look good for future procedures. That would have meant another procedure at about 63. It could be TAVR, if I qualified, but there is no certainty that anyone will qualify for TAVR. And honestly, TAVR at 63 is probably not a good idea. It would be expected to last 5 to 10 years and the surgery following TAVR is a very high risk one. Some will say that you might be able to do TAVR in TAVR at that point, but consults with my cardiologist convinced me that this would just be a bandaid for a few years and not a good one. With TAVR in TAVR there is so much junk in that valve that you have a very low cardio output, and probably can't do much more than walk and still face a very high risk surgery on the next round, which will probably be just around the corner.

At 45 you are 8 years younger than I was. Every guideline in every country indicates that a patient your age should get a mechanical valve, to have the best chance at a normal life expectancy, assuming that there are no contraindications to warfarin. Timmay indicated that he would probably go with Resilia if he was 65. That is about how I feel. I think that Resilia has a lot of promise and I would likely go that route if I was about 65, an age at which a tissue valve is expected to last longer and also an age at which we have less life expectancy remaining, increasing the odds that the valve will take you to the end.

Life on warfarin is just like life before warfarin. I run, bike, do Brazilian Jiu Jitsu, hike and swim. Don't let anyone tell you that you can't live an active life on warfarin- that is nonsense. I self manage and find it very easy to do and stay in range.

I was deciding between On-X and St Jude mechanical valves. My surgeon was willing to go with whichever I chose. But, he indicated that if I go with On-X, I would be on the proven INR range of 2 to 3, not the range tested in the PROACT Trial. He had some very negative things to say about the PROACT Trial and indicated that patients at INR of 1.5 to 2 are are high risk of blood clots- stroke. Ultimately, I chose to go with St. Jude.

So, there is no perfect valve. One choice means anti-coagulation for life. The other choice, at age 45, means future procedures and a lower life expectancy. But, as others will say, the only wrong choice is to not get the procedure. The choice is yours and yours alone to make. No one else will be the one who has to live with the consequences of your decision.

Best of luck in your decision and best of luck with your procedure, whichever valve you choose. It does not matter if you choose a valve different than what we would have chosen- we will all be here to support you no matter what.

LOVE THIS !!!!!!!!!!!!!!!!!!!!!!!

Superman · Aug 7, 2023

Mister_James said:
In the long run we are all dead.

US is very good at hiding health costs. You pay $45-$70 per paycheck for your company insurance.

So these folks send your a meter and strips and your deductible and sat its $100 for the year.

Your doctor sends you a bill for your insurance deductible and it's $35.

While the true cost for the year may be $1,500. You only know of your $135.

Next year your insurance moves from say $50 to $55 per paycheck. You don't think +20% You say duh $5...won't even get me popcorn at the movie theater

This doesn’t even address the sometimes 80% of the total premium many employers pay on behalf of their employees. But if it isn’t premiums and deductibles then it’s taxes. And as long as everyone wants Cadillac health care with MRI’s on demand, the cost will continue to escalate.

That’s the positive of the US system. Some countries you’ll have to wait for months or be truly medically necessary to get access to an MRI machine. We have so many machines in the US that doctors are looking for excuses to bill out tests on them. I can get an MRI any time I want (cardio has a standing order, but my echos are fine and I see no reason at all). They’ve basically said they’d just like one for their records.

As far as my cost for home testing - my machine is supplied, my test strips are supplied. Insurance fully covers as DME or something. I pay a $27 fee (up from $12 a few years ago) to have a doctor peak and say, “Yep, results reviewed. I’ll call in refills.”

Protimenow · Aug 7, 2023

There was a lot of good advice here.

I got my St Jude nearly 42 years ago. I didn't even consider a tissue valve at that time.

I've been self-testing and self-managing since 2009. Before that, I didn't go to the lab nearly as often as I should have, and I didn't even KNOW about 'Coumadin Clinics). I was lucky - no strokes (then) and no major bleeds (although some injuries DID bruise A LOT).

Being on warfarin isn't a nightmare. As Pellicle said, there are a lot of old wive's tales out there about coumadin - including the accurate but completely irrelevant old one about warfarin being rat poison (it is - but in massive doses).

You can learn a lot from us here.

If I had to do it again (and I'm in my early 70s), I would STILL go with a St. Jude mechanical -- although I may not last the 10 or 20 years that the Edwards valve would give me, I would still be more comfortable with a valve that just keeps working (and having to do a bit of INR management) than with one that may eventually have to be replaced (when I may not even be a good candidate for OHS or TAVR).

Groy · Aug 13, 2023

Protimenow said:
There was a lot of good advice here.

I got my St Jude nearly 42 years ago. I didn't even consider a tissue valve at that time.

I've been self-testing and self-managing since 2009. Before that, I didn't go to the lab nearly as often as I should have, and I didn't even KNOW about 'Coumadin Clinics). I was lucky - no strokes (then) and no major bleeds (although some injuries DID bruise A LOT).

Being on warfarin isn't a nightmare. As Pellicle said, there are a lot of old wive's tales out there about coumadin - including the accurate but completely irrelevant old one about warfarin being rat poison (it is - but in massive doses).

You can learn a lot from us here.

If I had to do it again (and I'm in my early 70s), I would STILL go with a St. Jude mechanical -- although I may not last the 10 or 20 years that the Edwards valve would give me, I would still be more comfortable with a valve that just keeps working (and having to do a bit of INR management) than with one that may eventually have to be replaced (when I may not even be a good candidate for OHS or TAVR).

thank you for your response.

42 years! thats impressive and encouraging!

it's interesting how the advice can variate from doctor to doctor, my surgeon told me on-x was way better than st jude's ... that st jude's was too trombogenic but 2 of the others 5 doctors I visit they quote me st jude's and no other options and I can see there's a lot of success, and time proven, stories with st judes.

still I elected On-X,... hope I don't regret it.

hope your St Jude's lasts for many many years more

pellicle · Aug 13, 2023

Groy said:
42 years! thats impressive and encouraging!

basically unless there's some other reason involved mech valves typically just last your lifetime.

From @dick0236 's profile

Aortic valve replacement at age 31(Starr-Edwards mechanical "caged ball" valve) Aug. 1967. His original Starr-Edwards valve is still functioning normally and is believed to be the longest operating valve in history.

I'll leave it as an exercise for the reader to determine how long his valve has been in place.

Properly manage your INR and you'll live long and prosper

it's interesting how the advice can variate from doctor to doctor, my surgeon told me on-x was way better than st jude's ... that st jude's was too trombogenic but 2 of the others 5 doctors I visit they quote me st jude's and no other options and I can see there's a lot of success, and time proven, stories with st judes.

its a point that's often lost on "black and white thinkers" on here that there is difference in medical opinion. Typically the first opinion they get which fits their already preformed view (which they then tell you they seek to educate, although I believe they mean "consolidate) they latch on to as "the truth".

The truth is more like an eel in a bucket, at first glance it appears you should be able to just reach in and grab it.

Best Wishes

Chuck C · Aug 13, 2023

Groy said:
it's interesting how the advice can variate from doctor to doctor, my surgeon told me on-x was way better than st jude's ... that st jude's was too trombogenic but 2 of the others 5 doctors I visit they quote me st jude's and no other options and I can see there's a lot of success, and time proven, stories with st judes.

Yes, it is interesting how much expert advice varies.

Your surgeon indicated that St Jude is too thrombogenic? That is not what the literature suggests. This head to head comparison of the St. Jude vs the On-x is worth the read:

"Conclusions"

"The On-X valve and St Jude Medical valve performed equally well in the study with no differences found"

https://www.jtcvsopen.org/article/S...ions,Developing more than Western populations
Both valves had very low levels of thrombosis. They are both good valves.

It should be noted that the study linked above was not using the INR range of 1.5 to 2.0 for the On-x. That lower INR study, the PROACT TRial, found higher rates of stroke for the low INR folks than those at 2.0 to 3.0.

Groy · Aug 13, 2023

One Month after my surgery now, and happy
everything was a bliss.

minimally invasive surgery (mini sternotomy)

only one day on intensive therapy and two days on room, felt strong for walking I even made a squat

the only pain I felt was in my back and only when coughed hurted my 5cm (2 inch) cut in the right of my chest, was not a big deal of a pain. although all the tubes and cables comming out my body was kind of anxious but only psichologically they dindn't hurt.

even so it was not a jolly ride, but I am aware that there are people who suffered much worse.

elected mechanical On-x valve.
prescrived acenocoumarol (a warfarin relative I believe).
INR between 2.0 and 2.5 must.
INR checked by laboratory now, I'll buy coaguchek

Chuck C · Aug 13, 2023

Groy said:
INR between 2.0 and 2.5 must.

Excellent. Glad to see that your medical team did not fall for the 1.5 to 2.0 INR marketing BS!

Cool that they took photos of your procedure. They did that for mine as well. Your valve looks like mine did- like a deep fried calimari!

Inspiris Resilia vs On-x, can't decide

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