? Advice for young friend

[Marty]

I have a young friend , age 45, who had aortic valve replaced eight years ago, Carpentier-Edwards bovine. Now told he needs redo next six months. He is active and athletic. What would you advise him to do? Bio or mechanical?
What about warfarin? Risky? Too much trouble? Are the new mechanical valves almost ready for aspirin only? We'll be interested in your comments.

 

[Dustin]

I'd say mechanical, considering his age and activity, and the fact that his tissue valve expired pretty quickly.

 

[Ross]

Being that we are talking within the next 6 months, I'd have to side mechanical. If only the new generation tissues were out now and proven reliable way beyond current tissue valves, I'd say go with one of them, but that's not the here and now. Marty it's hard to say if and when On-X could go aspirin only. It's certainly not going to be in the next six months.

 

[Cooker]

I'm with Ross. He will need OHS number 3 if he goes tissue. Warfarin is no problem for me. I think most would agree.

 

[Karlynn]

If I found out now that my St. Jude needed replacing, at 47, I'd probably go with the On-X.

 

[Mary]

Marty,
Why did he pick the bovine eight years ago? He would have been 37? That is young for a nonmechanical.
I think if I had to choose ten years from now, I'd still go bovine. That would make me a potential 3 OHSer too . . .

 

[Kate]

Hi Marty!
Like your friend, I chose to go with a bovine valve at a young age - 38. I'm very happy with my decision but, for what it's worth, have decided to go mechanical next time if I require a redo in less than 10 years. More than 10 years and I feel very confident I can make it to the end of my life with only three surgeries (still alot but doable). Under 10 years and there seems a reasonable chance I could end up looking at a fourth, at which point the risks get higher than I'm comfortable with. Good luck to your friend! Kate

 

[Paul]

Hello!
What does On-X mean?
I got my Bovine last year when I was 34 and hope it lasts till there is a third alternative. I think it's unreasonable to try and calculate how many surguries based on today's technology. So, that was a big reason i went tissue, that along with lifestyle of course. But what does On-X stand for?

Also, check this out:
http://www.valvereplacement.com/forums/showthread.php?t=17454

 

[geebee]

Hello!
What does On-X mean?
I got my Bovine last year when I was 34 and hope it lasts till there is a third alternative. I think it's unreasonable to try and calculate how many surguries based on today's technology. So, that was a big reason i went tissue, that along with lifestyle of course. But what does On-X stand for?

Also, check this out:
http://www.valvereplacement.com/forums/showthread.php?t=17454

Yeah, but all we have is today's technology. There is no guarantee things will progress although it is probable. For all we know, what we have today might be the best there is. I hope that is not the case because there are a lot of good people on this site hoping for progress but I, personally, am not a gambler. I deal with what is in front of me and have learned not to get my hopes up.

I am not sure On-X stand for anything. It is merely the name of one of the newer mechanical valves on the market.

 

[ALCapshaw2]

On-X is the name of a third generation Mechanical Valve with greatly improved hemodynamics and reduced likelihood of clot formation. Studies are underway to see if reduced anticoagulation is viable across the board. Studies are also underway to see if Aspirin Only therapy is viable.

The claims are impressive and promising, AND, if they all come true, one can claim a 'Home Run' by selecting that valve NOW.

See their website or do a SEARCH on VR.com for On-x to review considerable discussion of this and other third generation valves (e.g. ATS, Sorin, St. Jude Regent).

'AL Capshaw'

 

[davidfortune]

Paul,

On-X is a mechanical valve manufactured by MCRI (Medical Carbon Research Institute) whose founder was involved in the creation of pyrolytic carbon that is used in almost all mechanical valves today. MCRI has created the next step of ultra-pure, non-alloyed pyrolytic carbon (dubbed On-X carbon). On-X Carbon has higher tensile strength with less brittleness than the silicone alloyed pyrolytic carbon in use in mech valves today. This higher tensile strength and added flexibility allows for design improvements that will hopefully (maybe?) lower the anti-coagulation requirements of the On-X valve. This valve also has better hemodynamic performance than other mechanical valves. Longevity? - in use in Europe since 1996 and USA 1998 (mitral position) and 2001 (aortic position).

Hopefully a mech valve with a future of aspirin only anti-coagulation (FDA studies on the reduced anti-coagulation regime with On-X are now underway).

 

[Joe Cool]

I feel that one surgery is too many! I am 49 and have a St. Jude. I am not a risk taker so I went with what IS concidered the "gold standard" for mech valves (30 year track record). If I was in my 60's I would concider a tissue valve, but since I am not I a glad I have a valve that will last several lifetimes. Like I said one surgery is too many for me!

 

[Paul]

Thanks for the quick primer on the On-X valve! Very exciting.

I don't consider my self a risk taker at all. Although the 'one surgery is too many' perspective is certainly extremely valid. I considered my lifestyle and concluded surgery under controlled circumstances was less risky. Four surgeries on the other hand sounds like hell. I was told that my second surgery hopefully in my upper 40's would be similar in risk to my first which was similar in risk to living on anti-coagulant. I am young, otherwise healthy and not over weight so my risk was as low as possible for OHS.

Geebee,
I think it is 'certain' things will progress. However, it is NOT unreasonable to calculate # of surgeries as I wrote. In fact it?s all we can do beside hope. Eventually there will be a valve that lasts a lifetime without anti-coagulants; but there is no guarantee it will come along in the next 15 years.

I am troubled by how often I read that a tissue valve didn't last 10 years. I was told to expect 14 to 18. But as a young active person I think the lower number should be expected, but less then 10 would be upsetting and would have made me think harder about the St. Jude.

 

[Mary]

We have two current threads running that show the impossibility of predicting, with certainity, the longevity of any valve type after replacement.
It's always going to be a calculated gamble with what fits best with your life circumstances. So no one should knock themselves for the choice they made.

 

[Kate]

I am troubled by how often I read that a tissue valve didn't last 10 years. I was told to expect 14 to 18. But as a young active person I think the lower number should be expected, but less then 10 would be upsetting and would have made me think harder about the St. Jude.

Hi Paul!
As I mentioned above, I am (like you) a relatively young person who did the comparisons between life on coumadin and multiple surgeries and decided to go with a biological valve. While I'm very happy with the choice I made and would do so again, my research suggests that you may have been given somewhat unrealistic expectations when told to expect that your valve would last 14 to 18 years. I'm not saying it won't last that long - it might. However, according to the manufacturer's own data, a 40 year-old person has about a 50/50 chance of getting 15 years out of their bovine valve. Of course, you're a little under 40 and the valve you received is slightly better than those they made 15 - 20 years ago, so these statistics are not an exact fit. Still, generally speaking, there is probably nearly as good a chance that your valve won't last as long as you've been told to expect as that it will. In my opinion, a more accurate estimate for someone in our situation is ten to twelve years as that is what we can reasonably count on (recognizing that Mary is correct that no one can predict in any one situation). That said, I hope we are both the lucky ones who make it to 18! Kate

 

[Bryan B]

Interesting thread. I ended up choosing the Ross Procedure hoping to "have my cake and eat it too" (whatever that saying means ). When I had my surgery 2+ years ago my backup plan was the Carpentier-Edwards bovine valve (at age 43). Luckily my surgeon felt I was a perfect candidate for the RP (did not have a BAV). In hindsight, and having gone through the surgery and recovery, if my surgeon had to go with the backup plan I think I would choose the On-X mechanical valve. While my surgery went very smoothly I would not be looking forward to a 2nd surgery much less a 3rd one. Even if the On-X turns out not to be approved for aspirn only therapy, in my opinion there is already enough evidence that the On-X is more resistent to clot formation and would reduce the risk of stroke if ones INR level slipped into what is now considered the danger zone. It may also be beneficial to have an On-X valve if one is faced with invasive procedures post valve surgery. Having said all that...choosing which type of valve surgery to have was the most difficult decision I have had to make in my life. If faced with having to make the decision again in the future I would have to weigh all of the options all over again, and I couldn't say with 100% certainty what type of valve I would choose.