Inspiris Resilia vs On-x, can't decide

Groy · Aug 13, 2023

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

I know, I was happy when I heard my surgeon

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!

pretty ugly

, my doctor explain me with the photos the parts where was sick and calcified and show me the mini hole where my blood was flowing

Regards

pellicle · Aug 13, 2023

Groy said:
prescrived acenocoumarol (a warfarin relative I believe).
INR between 2.0 and 2.5 must.

that's a bit tight but you need to also be aware that it has a *very* short half life (under 11 hours) meaning that its likely your INR can vary during a 24 hour period and a missed dose will see you out of range more or less that day.

I would encourage you to pick a target INR of 2.5 (not making 2.5 the upper bound of a 2.25 target), I'd also make even more sure you have checks and double checks to ensure you don't miss your pill. I'd discuss moving to warfarin if you end up finding that you can't maintain that.

dick0236 · Aug 14, 2023

pellicle said:
I would encourage you to pick a target INR of 2.5 (not making 2.5 the upper bound of a 2.25 target), I'd also make even more sure you have checks and double checks to ensure you don't miss your pill. I'd discuss moving to warfarin if you end up finding that you can't maintain that.

I agree with Pellicle and would also open up my INR range a little too......2-3. A .5 range is very challenging and, in my opinion, unnecessarily tight.

Also, get a seven-day pillbox (even if your anti-coagulant is the only medicine in it). It'll be the best 79c you'll ever spend.

Groy · Aug 14, 2023

pellicle said:
that's a bit tight but you need to also be aware that it has a *very* short half life (under 11 hours) meaning that its likely your INR can vary during a 24 hour period and a missed dose will see you out of range more or less that day.

I would encourage you to pick a target INR of 2.5 (not making 2.5 the upper bound of a 2.25 target), I'd also make even more sure you have checks and double checks to ensure you don't miss your pill. I'd discuss moving to warfarin if you end up finding that you can't maintain that.

Just got my inr results today = 3.20
Took 1 tablet yesterday

Last week my inr was 2.48 with half tablet taked the day before.

I think half tablet is my sweet spot & I'll try to keep my inr in that number (2.5).

Next week, next test with half tablet every day at 5pm

Regards

pellicle · Aug 14, 2023

Groy said:
Just got my inr results today = 3.20
Took 1 tablet yesterday

hard to know what it means when I don't know how many milligrams that is. Coumadin was this:

so its hard to know what your dose is.

If you feel like reaching out I'll set you up with a much more numerical way of keeping track of this and making good dose decisions when its not "steady as she goes" with respect to INR being in range.

Best Wishes

Groy · Aug 14, 2023

dick0236 said:
I agree with Pellicle and would also open up my INR range a little too......2-3. A .5 range is very challenging and, in my opinion, unnecessarily tight.

Also, get a seven-day pillbox (even if your anti-coagulant is the only medicine in it). It'll be the best 79c you'll ever spend.

First thing I buyed, the 7 day pillbox and time alarms in every gadget I have, I'm very forgetful and don't want jeopardize my health.

Regards

Groy · Aug 14, 2023

pellicle said:
hard to know what it means when I don't know how many milligrams that is. Coumadin was this:
View attachment 889500
so its hard to know what your dose is.

If you feel like reaching out I'll set you up with a much more numerical way of keeping track of this and making good dose decisions when its not "steady as she goes" with respect to INR being in range.

Best Wishes

Sorry, you are right.

One pill = 4mg

If you feel like reaching out I'll set you up with a much more numerical way of keeping track of this and making good dose decisions when its not "steady as she goes" with respect to INR being in range

Any info will be very appreciated

pellicle · Aug 14, 2023

Groy said:
Any info will be very appreciated

reaching out involves you sending me a "PM" which is under "Start a Conversation" which is then of course private

I'd anticipate you'd send me a phone number, we can talk and discuss what's wot.
Best Wishes

dornole · Aug 14, 2023

Wow just like the car dealership - they send me photos of parts replaced too. It’s funny how you can just sense “whoa that looks janky” even without expertise. I felt like that watching my first echo when they got to the mitral valve. Glad you’ve got a good replacement and it went pretty well for you.

tom in MO · Aug 15, 2023

My range is 2-2.5 and I can easily stay in range most of the time. I used to be 2-3. It wasn't harder to move to 2-2.5.

It's like Goldilocks principle, you need to find the dosage that's "just right" to get you in range that's "just right."

Erwitchin · Mar 27, 2024

BillDaThrill said:
Groy, sorry about your need for surgery but I commend you for arriving at the decision point that many of us have faced. Understand that there is no right answer - only what is right for you. It's all about what you value most. For me - I placed the highest value on the greatest potential for a 'one and done' surgery so I went On-X at age 52. Two years later, I am thrilled with how I am doing... skiing, trail running, mtn biking, weight lifting, volleyball - am back doing all I love and much stronger than when I was struggling before surgery. Have only had one bleeding incident and that was me being dumb and not talking to my cardiologist before having a nose polyp removed. Quite messy - but dumb/preventable. The Inspiris is a great valve and yeah, the potential for TAVR - and a more resilient TAVR - is there. Impossible to know. Wishing you the best but know that the mechanical valve option shouldn't hold you back too much.

Can you heat the valve tick? I can not tolerate a ticking clock (I couldn't sleep for days until I found and killed an old timey alarm clock in a drawer in another room)

pellicle · Mar 28, 2024

Erwitchin said:
Can you heat the valve tick? I can not tolerate a ticking clock (I couldn't sleep for days until I found and killed an old timey alarm clock in a drawer in another room)

just an observation

a clock somewhere or a dripping tap (both drive me nuts and that's a long story) however they are all external things. My heart beat has always been "my" heart beat and I feel it / am aware of it internally. I know it well because when I play sports or am doing meditation I'm aware of it. All that happens is that the perception of your heart changes in intensity.

I don't hear it, I feel it (although my ear drums pick that sound up just like if I tap you on the head). So sticking in ear plugs I have always been better able to perceive my heart beating.

Others will hear it as a ticking (but so far I've never heard of anyone here asking "will the ticking bother my partner" which seems to be an interesting psychology to me).

Best Wishes

Protimenow · Mar 28, 2024

When my valve was new, it was louder than it is now (32 years later). It never really bothered me.

But my kids were young, and I was never able to play hide and seek with my kids because they could hear me when I was hiding behind a door (or other places).

I've told this a few times - but not yet in this thread:

I was at a press conference in Atlanta, and a person in the row in front of me, kept turning around and glaring, annoyed, behind him. As if I could broadcast my ticking more effectively, I opened my mouth and aimed it at this guy.

After a few minutes of annoying this clown, he turned around and asked, loudly, 'who's wearing the cheap watch?' I said, equally loudly (I think) that 'it's my heart valve that you're hearing.' THAT shut him up and probably embarrassed the hell out of him.

For me, if I had it to do again, I would choose a mechanical valve again - the biological valves - for me (even though I'm now stuck in my 70s and I'm not sure how many weeks are left) I'd still opt for mechanical. I'm not convinced you can really compare a tissue to a mechanical valve.

As for ticking and anticoagulation management - the anticoagulation management isn't really that big a deal, and the ticking doesn't really become much of an issue.

tom in MO · Mar 29, 2024

Erwitchin said:
Can you heat the valve tick? I can not tolerate a ticking clock (I couldn't sleep for days until I found and killed an old timey alarm clock in a drawer in another room)

I don't like mechanical clocks in a bedroom either. However, I got a mechanical valve and it didn't keep me awake. The ticking went away over time and I pretty much don't hear it unless I concentrate and the room is quiet. Not sure if its due to hearing loss due to old age though.

ATHENS1964 · Mar 29, 2024

Important for me is that science and technology kept me alive, the choice of valve has many parameters apart from age, for example atrial fibrillation - kidney failure - pulmonary problems etc. all these must be evaluated not only by the cardiologist but also by a good pathologist who can put the puzzle together.
Let's be happy that we have solutions and not complain, I was aware of the seriousness of such a big operation that the last thing that concerned me was the noise.
I had read many articles before the surgery and I knew what would happen every moment after the anesthesia in the intensive care unit.
I didn't have any tubes so I say +1 then I moved my legs and arms to see if I had a stroke +2 everything was fine then I saw on the monitor the rolls and the day and I asked the nurse if I had a pacemaker. +3 .
it is important that the surgery goes well and not the noise of the valve

tommyboy14 · Mar 29, 2024

Erwitchin said:
Can you heat the valve tick? I can not tolerate a ticking clock (I couldn't sleep for days until I found and killed an old timey alarm clock in a drawer in another room)

I can hear my valve tick. It isnt a quite one. My kids can hear me tick when we play hide and seek. But I had two OHS now. I feel warfarin + ticking is a very good tradeoff for a high chance of no more surgeries. Although I did well both times, I did have brain fog for some time after. I would rather not go through it again. A mechanical valve is not a 100% guarantee of no more surgeries. But it is 85-90%. That is excellent relative to all other options. At your age, with a bio valve, that is the chance of reoperation sometime later in your life.

newarrior · Mar 30, 2024

Interesting and thanks..I am 61 looking at Resilia but have high LPa and calcify fast so...)

Protimenow · Mar 30, 2024

The story (myth? wishful thinking?) is that when the tissue valve fails, technology would be able to repair that valve with a TAVI or TAVR, so another OHS wouldn't be necessary. They probably don't say that THESE can also wear out, and the diameter of the valve opening gets smaller and smaller (although this may not be a big issue if you a) die before you need the next repair or b) probably need the valve replaced with a mechanical or tissue valve). I'm still waiting for a replacement valve that they can insert transnasally - and I'll bet that this will NEVER happen.

Habana58 · Mar 30, 2024

INR Ranges for AVR: I have an OnX AV since 2015, and for the first year i followed the 1-5-2 range , but the problem is Not that it does NOT work, the problem , 'for me' is the fact that 1- asa + warfaring will produce bleeding events with long term usage (n it happened to me after 5 years , long story), 2- It is very taxing to keep an eye on the 1.5 thing, so i moved to the 2 - 3, target 2.3; According to some medical papers, see the one attached, IF you TEST WEEKLY and you have XXI Mech Valve in the Aortic position, you can set your target range to 1.8 - 2.8; IF you test WEEKLY, no matter if it is the St Jude or the OnX offspring. There are many papers out there, but found this one interesting,.

Habana58 · Mar 30, 2024

The Tissue vs Mech dilema, boils down to the fact of you would like to stay in hospitals and plan to be there 2 or 3 times, and hope all goes well on the 2nd and 3rd time; and "hope" the TAVI "could" be done, is not a 100% for sure; hope that you will never get AFIB or anything else that will force you to take.... Warfarin no matter what tissue valve it is; or just get a Mech Valve manange the Warfarin thing and most likely you will never ever see your surgeon again, it is possible, but not likely; Endocarditis happens with any type of valve; and also "for me" we all know how good certain enterprises are at making sure they get repeat customers, not saying it is the case but is possible; And as for longevity, according to the attached study, people with mechs live longer; just a thought.

Inspiris Resilia vs On-x, can't decide

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