Almost Time for a Reoperation

[Bob in Colorado]

Hi all. I have been reading this great forum for the past few weeks and thought it was about time to register and to introduce myself. As you can see I am Bob in Colorado. I am late 50s, fit and healthy overall and stay active with hiking, biking, swimming, and sports including tennis, raquetball, and squash.

I had an aortic valve replacement (bicuspid valve with severe stenosis and severe regurgitation) in March of 2000 at the Cleveland Clinic at the hands of Dr. Joseph Sabik. He worked right under Dr. Cosgrove. We used an aortic homograft. At the time they were thought to be one of the best choices for an active person of 48. The thinking was they would last 25 years or more. Now we know that is just not true, and that homografts are not lasting any longer than other tissue valves. It is now about 9 years and I have moderate to severe aortic reguritation - but no stenosis. I still feel pretty good but I am starting to have some symptoms, mostly arhythmias so I am on a low dose of beta blocker which works quite well.

My cardiologist says it is time for a reoperation and is adamant about a mechanical valve (he highly recommended a mechanical valve in 2000 as well). It has been great having a tissue valve and leading a very normal life for the last 9 years but I am afraid of selecting a tissue valve again and quite likely signing up for a 3rd open heart surgery in 15 to 20 years.

In researching the various mechanical valves the SJM valve comes up over and over again by my cardiologist and the 3 surgeons I have spoken too. My internet reading has led me also to the On-X which has a terrific and compellilng web site. There does seem to be several refinements over the SJM valve. I'd like to go that way, but the surgeons I have spoken with seem to want to stay with the tried and true SJM. I am just now in contact with the On-X people and intend to learn more. I was planning to have the reoperation by my same surgeon in Cleveland but his nurse tells me he recommends the SJM.

Last time I tried the homograft against the recommendation of my cardiologist - and it turned out he was right. I hesitate to disregard his advice a second time. What do you think? Is there anyone here who has an On-X and is truly conviced it is the next generation of mechanical heart valve? Is it really quieter that the SJM? This is a major consideration for me.

Thanks so much, what a great group! I'm lucky to have found you all.

Bob

 

[Lionheart]

Hi Bob,
Welcome aboard fellow Coloradan! There are a few of us at this site. While I can't help you with your valve questions, I do know that there are surgeons at Cleveland Clinic that recommend and prefer to use the On-X valve. And from what I've read here, both the SJM and the On-X are excellent mechanical valves. I'm sure others with greater knowledge will chime in by tomorrow and help with your questions. Good luck with your choices and keep us informed.

Take care,
John

 

[Woodbutcher]

Hi Bob,
I have an On-X valve, I've had it for nearly six weeks now so still mending and healing but on the road to recovery. I've no idea how quiet it is compared to the SJM but it's not as quiet as I'd hoped ! I think like all these things it's down to the body type of the individual. I know a chap who had his On-X over a year ago and insists he's never heard it !? That's hard to believe. I have to say that after six weeks I'm hearing mine less and less. I dont think it's getting quieter, it's just that my brain is filtering the noise out more ? A bit like living next to a busy train station and not hearing the trains ? It sounds louder to me than anyone else, others can only hear it if they put their ear to my chest.. But
I'm sorry to hear your old valve is failing so early but wish you well with the next one.
Ps. I found the people at On-X to be really helpful, responsive and friendly.

 

[Curtsmum]

I asked the same question not so long ago. Its a difficult question because everybody as there own oppinion as to which valve they prefere. Our surgeon says he will use the St Jude but it is for my son not me and he as not long had a repair, so i don't have to go into this just yet. I will disscuse the On-x with the surgeon but will probably end up going with the surgeon.
Your best bet is to do as much research as possible and choose what you feel is best for you, not easy Wishing you all the best.

 

[Phyllis]

Just want to say welcome. There are quite a few here who have used the On-X and I'm sure they will chime in soon. Be sure to let us know when you have a date so we can add you to the calendar and make it "official"!

 

[Mary]

Hi Bob and welcome!
If you'll use the search feature at the top of the page, I think you'll find many threads that discuss the on-x and several that discuss the amount of noise that they experience with their mechanical valves.
Good luck!

 

[skeptic49]

Welcome to the forum, Bob. Sorry that you need a reop so soon and I hope you can resolve the surgeon/valve choice issue to your satisfaction.

Jim

 

[ALCapshaw2]

Bob -

Since you have indicated that you wish to return to the Cleveland Clinic for your second AVR and you have an interest in the On-X Valve, you may want to talk with Dr. Pettersson at CC. It is my understanding that he has implanted several (over 50?) On-X Valves. Also note that On-X is now one of the approved Mechanical Valve Choices at CC (I'm guessing due in part to patient demand).

FWIW, we have several members who convinced their Surgeons to implant an On-X valve and were the First On-Xers for their respective surgeons, including one at CC. All reported No Problems with the surgery.

'AL Capshaw'

 

[Bob in Colorado]

Hi all, thank you so much for your welcome and for your words of encouragement. Having been through the surgery once before (and not long enough ago!) I know what a big deal it is and will be. I appreciate the advice and support. In particular I thought it was interesting Lionheart that you also chose Cleveland Clinic, they have such good numbers and such a good track record for innovation. Woodbutcher, thanks for your comments. It is great to communicate with someone whoa actually has an On-X. At 6 weeks, you are likely just starting to feel like yourself again, with the degree of stenosis you had you will be amazed at the degree of LV mass regression that will happen, and how well you in feel in another 6 weeks. I got progressively better and better for a year or two and just felt terrific! Curt'sMun, Phyllis, Mary, and Jim, thanks for the well wishes. Jim, hang in there and wait until the right time. Al Capshaw, I am in touch withe Catheran at On-X and hope to learn more.

Thanks again to all.

Bob

 

[Duff Man]

I would probably pick an on-x valve if it came with a pre-sewn conduit. In other words, if I was having a simple AVR, I would definitely pick the on-x valve and I would change surgeons to get it done - within reason. Petterson certainly has an unremarkable reputation and apparently he doesn't mind innovation.

Although I'm not totally convinced on the credence of the statistics, I'm aware that africans are running around non-ACT compliant and they're not stroking out. I find that to be a pretty strong indicator that you can be less religious with ACT and feel a little safer about accidentally missing a dose here or there. I'd probably feel less anxiety about going on a trip out of the country or in to a remote area and losing my pills or getting them wet, or something.

 

[briansmom]

I chose an On-X for my son. When I told the surgeon I wanted an On-X he was fine with it even though he had to sew on the dacron ascending aorta for my son. I know the surgeon had never used an on-X before I talked to him about it, but there was a few months between the discussion and surgery and he may have implanted a few before my son. After my son's surgery I overheard him telling someone that the On-X was the best valve being made and that he implanting a lot of them. I chose it specifically because I hope that it will allow a low level of anti-coagulation. My son no longer races a dirt bike but he does drive and race in an off-road car now. Brian's was implanted almost 2 years ago He has not always been great about taking his meds (teenagers!!!!!) so I really hope the low anti coagulation turns out to be true.
I don't know if it is any quieter than the SJ but I think that you get used to it.

Please keep us posted on how you are doing.

 

[Eva]

Welcome aboard, Bob,

So sorry that you have to be reopened sooner than you were hoping to. Wish you luck in your choice. To answer your question about the noise, I have a new Regent SJ and now after four months, I hardly hear the ticking and when I do it is very faint!

 

[vprnet]

Welcome Bob,

I recently had my BAV replaced with a 27mm ON-X and a Dacron conduit for my ascending aorta at NYP Weill Cornell. I can tell you that my excellent surgeon normaly uses SJ valves and I believe I was his second patient (in a matter of one month) to request the ON-X (for all the reasons you have read about).

He had no problem with the request and after the surgery was very pleased with the outcome. I can remember when I was in ICU while being checked on by three doctors I overheard one of them say after approaching my chest (I was in a semi cohearent state) that the valve was "quieter".

Now four weeks out of surgery I cannot hear the valve tick at all, in part I am sure because the mind tends to tune it out anyway. But I believe the two point landing and angle of the leaflets helps to reduce the mechanical impact on closure. But this I think is the least important of the key design improvments in this valve.

BTW, if you need a dacron conduit, keep in mind that even though SJ has a model with the conduit integrated, the many patients that request a tissue valve and need the conduit also must have the conduit added to the valve during surgery so this it is no big deal for the ON-X either.

Best of luck with your decision.

Vincent (54)
BAVR with 27mm ON-X NYP Weill Cornell Dec 19, 2008.

PS. I am not a medical professional or a doctor. My comments in this forum are my own opinion and are not intended to be given as medical or professional advise or a recommendation of any valve choice. Decisions that affect your health and wellbeing are ultimately yours and your doctors. vprnet

 

[dlangton]

pigs and cows 'n' stuff

pigs and cows 'n' stuff

I certainly understand your hesitation to get another tissue valve but nobody else is sticking up for them here so I'll just mention something that I'm sure you know already, which is that there has been a lot of development over the last decade and tissue valves are now expected to last considerably longer than the previous technological generations of pig and cow valves. I don't know what your cardio-dude told you ten years ago, but before my operation two years ago I even had cardio-doctors telling me that tissue valves last only 5 years, and they were simply and commpletely wrong. I got my tissue valve at age 56 and it sounds like you're a bit older, so you know what my advice is likely to be. I expect my valve to last a good 20 years and maybe a lot longer, and you would be approaching your 80th birthday before a reoperation might become necessary -- though of course we don't know that for sure because the data has to be compiled over that actual period to be reliable.

The other point I find myself making to valve choosers is that the technology twenty years from now will certainly be a lot better than it is now, and replacement valves will probably be grown from one's own stem cells or something similar. It's hard to imagine a more perfect solution. If I'm still kicking at eighty years and my valve is pooping out, a reoperation might be pretty attractive for that reason and also because improved surgical methods will likely eliminate the need for sternotomy in most cases so the ordeal will be that much easier.

Right, and when I was smoking camels along with the other highschool rabble in the mid-sixties, we thought we'd be impervious to health consequences because "they" will come up with a "pill" that takes care of all that.

But no, really! This is different!

 

[Kathy McCain]

Tissue valve

Tissue valve

Hello, dlangton,

I had my aortic valve replaced last Feb, at 56 yrs. I also, was told it may last 15,or twenty years. (Medtronic Mosaic 3rd generation)

What type of valve did the surgeon implant? I am wondering how many people out there have a Medtronic? I certainly hope they have much better technology in 15 or so years. I did have some complications, and definitely do not want my sternum cut again! The valve is doing great!


Best of luck! Kathy

 

[Woodbutcher]

Thanks Bob for suggesting that I'll "be amazed at the degree of LV mass regression that will happen", because I had very severe stenosis pre operation, but could you or anyone else for that matter tell what it means ?! Thanks.
Justin

 

[Donna]

To all of you who are interested in the on-x I know someone whio is in the trial sudy for low doeses of medication. he have had a blood clot inhis arm once and now he is on Plevix and 325 mg of asprin.

Hope this is hopefull information for you.
Donna

 

[Adrienne]

Thanks Bob for suggesting that I'll "be amazed at the degree of LV mass regression that will happen", because I had very severe stenosis pre operation, but could you or anyone else for that matter tell what it means ?! Thanks.
Justin

Because of the stenosis, the left ventricle became larger so that it could compensate and pump more blood. Now that you have a new valve, the LV will most likely remodel itself and become smaller.

 

[JeffM]

Medtronics

Medtronics

Stats are great but we don't all fall within the bell curve of patient profiles. I chose my tissue valve (the surgeon selected the actual device and size, of course) because I'm hoping to get 15 - 20 years out of it. Maybe it'll be 25 but like any other choice it could be less for a variety of reasons. No guarantees, right? I'm 53 now. I'm prepared to go through the sternotomy again, if necessary, but with any luck I can get my next valve with a less invasive procedure safely. And, perhaps, the On-x or some other alternative will have proven itself as the best choice at that time. My 4 week echo showed significant remodelling and I'm keeping fingers crossed for more of the same at my next echo (currently 4 months post op). Such a personal decision though.

 

[dtread]

Bob in Colorado asks:

"What do you think? Is there anyone here who has an On-X and is truly conviced it is the next generation of mechanical heart valve?"

Bob, you have a choice to follow your Doctor's advice, or to do research on your own and go with your own choice. Your choices thus seem to be: 1. Follow Doctor's advice and go with St. Jude., or 2. Go with On-X, which is not the first choice of Doctor but may seem more reasonable to you. Several folks have also chimed in with a 3rd choice; i.e., 3. Go with tissue valve, which was not really part of your question, but could certainly be put on the table.

This same question and these same choices come up about every two weeks in the valve selection forum, perhaps worded slightly differently but essentially the same. You can go back through forum discussions of valve choice over the last year or two and find very heated discussions on the same subject.

The short answer to your question is, yes, I believe that the On-X has enhancements that make it a better valve, which is why I specifically requested it, although my surgeon preferred the St. Jude. I thus became the first On-X implanted by my surgeon, and the first On-X implanted at Washington Hospital Center. Over time I have become more convinced that I made the right choice.

The one question you have to ask yourself is: Who has to live with the results of the decision? The answer, of course, is you.

Also, to answer your question about how loud the On-X is versus the St. Jude. I have no idea how quiet or loud a St. Jude is, but I can say that my On-X is practically silent. A very quiet valve. I rarely hear it.

Best wishes for a successful journey over the mountain, whatever choice you make.