Help needed on choosing the promising mech. aortic valve - St.Jude v/s On-X

[Tejumurthy]

Hi All,
Thank you all for your wonderful help to the community!!

I'm a 36 year old, having Bicuspid aortic valve (mild-moderate steanosis and regurgitation) with ascending aortic aneurysm. Scheduled heart surgery at Cleveland clinic on Sept 18th.

Though I some what managed to arrive on mechanical valve, now not able to make decision on which mechanical valve to choose from either of On-x or St. jude.

It looks like my surgeon is favor on St.Jude, though am little positive on On-x valve after reading forum responses.

Appreciate your help me in providing your inputs to choose the right valve for my BAV replacement.

And note, I will also be needing replacement for my ascending aorta.

Thanks,
Teju

 

[PGARG]

Hi Teju,
I am 41 and having my surgery next week. I have decided on the On-X valve. My surgeons favor the On-X valve here in california. Another opinion i got from a Stanford surgeon, favored the St. Jude valve. More research shows that there is not much difference in both valves. On-X claims to need lower Coumadin, but your doctor won't really put you on 1.5 INR. More than likely 2.0 INR, which is where St. Jude is.
St. Jude has a longer history, but On-X is designed by the same guy, and doesnt have any failures so far.
My surgeon actually has history with On-X at the Phoenix facility which was a participating center for On-X trials. She claims that she saw lots of tribal patients being on almost no blood thinning and still doing fine.

My own opinion is that both are really good. On-X i favor just a tad bit, because it may prove to have lower coumadin or might be able to use a different blood thinner in future. (trails are going on...but nothing soon).
Hope this helps. Good Luck!
-Pankaj

 

[Tejumurthy]

Hi Pankaj,
Thanks you for the valuable inputs.

All the best for your surgery

-Teju

 

[clay_from_nj]

Don't forget the ATS (now Medtronic). It's known for being very quiet (mine is) and was recommended for lower INR in at least one study way before On-X (http://www.ncbi.nlm.nih.gov/pubmed/12918853). All three are very similar and each is an excellent choice. I think that in many cases it comes down to what each surgeon is familiar and comfortable with.

 

[pellicle]

Teju

I have the ATS, but went in considering the on-x based , on the exposure to this forum. I deemed my surgeon knew more an me back then and so let him make the final call. Since then I have found that there is very little difference between them.

Whatone has as a bonus aenother has a different bonus. So end of the day all current pyrolytic carbon valves are good.

I don't consider the minute variations in Anti-coagulation therapy levels to be of any significance.

ATS gifted me unexpectedly ) with a coaguchek XS, which was nice

Best wishes

 

[Leah]

I have an ATS too. I was supposed to get the ON-X, but it didn't fit so my surgeon gave me the ATS instead. I have no complaints. Like Clay stated above, it's very quiet. Good luck w/ your upcoming surgery!

 

[Tejumurthy]

Thank you all for your splendid response. Until now i did not look into other valves other than St.Jude and On-X.

I will be exploring as much i can and discuss on the same with my CC surgeon.

@Pellicle,

It seems you are using Coagucheck XS, i'm planning to buy one. Does this covered with Insurance, if not what is the best place to buy one with reasonable price?

Thanks,
Teju

 

[pellicle]

Teju

I live in Australia, and know nothing about the US medical insurance maze. If I did not have one (or mine went missing / broken) I'd buy one for myself in a flash. Good ones can be found on eBay for not much and at online shops for not much more. Seems people buy them for "gran" who never needs it (or something like that) then sell them. (for instance)

Having had one for a few years now, I'd buy one out of pocket even *if* the insurance didn't cover it for the peace of mind. Personally having used it has stopped me wasting time at clinics and meant I don't need vein draws (which I dislike).

I would also caution you that (as you seem to yet have had surgery) to not expect it to be as easy to use as a TV remote control and so some patience will be needed in learning to "get it right" ... this will be tricky when you first start because it takes some months for your INR to settle post surgery (because you body is busy running around healing itself and your metabolism is not yet settled).

I personally (being a wild colonial boy) take full responsibility for my dose determination and my readings. I stepped into that gradually with a good 8 months at a clinic (who drove me nuts) and parallel testing before I cut over to "going it alone". I learned heaps during the clinic time and knew when it was time for me to "leave the nest".

Feel free to ask questions or search on the anticoagulation forum for many discussions.

best wishes

 

[epstns]

Teju - One thing to consider is the fact that although you may have a preference for one brand of valve over others, your surgeon usually has the final say in the matter. Some surgeons are much more comfortable working with one brand of valve, and if I was going in for another valve, I would probably go with the brand of valve my surgeon felt would be best. As pellicle noted, there doesn't seem to be much difference between brands of valves, and the anticoagulation protocols are basically the same, so your surgeon will probably decide which valve is best once he/she is "in there."

You've already made the critical decision to go with a mechanical valve (and I would agree with your choice - for you, not me. . . ), so why not discuss it with your surgeon and see what he/she suggests and why.

 

[dick0236]

@Pellicle,

It seems you are using Coagucheck XS, i'm planning to buy one. Does this covered with Insurance, if not what is the best place to buy one with reasonable price?

Thanks,
Teju

Teju, this depends on your health insurer. It is endorsed by Medicare and is covered as Durable Medical Equip. Usually will require going thru a monitoring service and is paid @80/20. Many non-mecicare insurers will cover self-testing, if prescribed by a doctor, similar to Medicare and you need to check with your insurer. I bought a meter and strips from Ebay for about 2 years until the recent probllem with INRatio. That was not covered by insurance and I paid about $500 for the meter and about $6 for strips/lancets. I now am enrolled in a monitoring service(out of pocket cost $6/test) thru Roche and use their CoaguchekXS. Both are good meters, but I think the CoaguchekXS is easier to use.

 

[Heart Of The Sunrise]

No Title

I went with the ON-X valve. See attached. I have Blue Cross-Keystone Health Plan East. (Pennsylvania) I am very fortunate to have such good insurance.
They covered my CoaguchekXS Meter and all the monthly supplies 100%. They also had an RN hand deliver it and train me how to use it.

 

[Tejumurthy]

Thank you all for the information.



@dick0236

Thanks a lot for the detailed information on Cogucheck XS and I will be contacting my CIGNA insurance for the coverage other options to buy one.

 

[tom in MO]

I let my surgeon decide, since he is the expert and i wanted him comfortable as well. He preferred st jude due to its long history and its tolerance to low inr, with a range of 2-2.5. Plus i am old fashioned in some things and i don't approve of onyx marketing. I think direct marketing of complex drugs and medical devices is unethical.

 

[Protimenow]

I began self-testing in 2009. I have a spreadsheet that covers all my tests, results, doses, etc. With the exception of my first meter (a ProTime that was sent to me as a gift), I've bought them all myself, on eBay. In addition to meters that were bought for grandpa or grandma, who died and no longer needs it, some of these meters came from clinics or hospitals that 'retire' them after a few years. They're still fully functional, but have been written off the books. If you keep an eye on e-Bay, you'll probably find an affordable meter before too long.

I've used many of the meters, and have even run parallel testing of InRatio, CoaguChek XS, Coag-Sense, and ProTime 3 against one or two labs. Personally my meter of choice is the Coag-Sense --- it's not quite as easy to find the meters on eBay, and it may be a bit more difficult to get supplies without a prescription, but it seems to report just SLIGHTLY below the labs. I'd rather have a meter tell me that my INR is 1.8, when it's actually 2.0, than have a meter tell me that my INR is 2.0 when it's actually 1.8. My second choice is the CoaguChek XS (don't, under ANY CIRCUMSTANCES buy a CoaguChek S -- you can't get strips for it). The XS is very easy to use, but in my experience reports .2-.4 higher than the lab. It may report EVEN HIGHER if your INR spikes above 3.5 or so.
Supplies for the XS are more readily available and you may be able to find an XS that's somewhat affordably priced. Keeping an eye on eBay listings -- and looking for occasional misspelled listings - can help you find one that may be an even better price.

I would personally avoid the InRatio -- not only are the strips difficult, if not somewhat impossible to get (because of a recall), I've found that my InRatio and InRatio 2 meters reported MUCH higher than the labs (and actually may have caused me to have a slight stroke).

My CoaguChek XS strips have run out, so I have to eventually get more so that I can continue comparisons to the lab and Coag-Sense results. I've got another meter - unavailable to mere mortals - that I may also start testing with.

As far as choice of mechanical valves goes -- I would probably trust the surgeon. Personally, I would be uncomfortable with an INR below 2.0 with any valve, unless there are many years of positive studies showing reduced risk of clotting for that particular valve.

 

[big_L]

My surgeon said he would use the St. Jude unless I asked for something else. I wanted the St. Jude. It was very important to me to get a valve that had been in use for years and had been 'installed' many, many times. While this probably also applies to the On-X, I believe it is a newer valve.

 

[Cooker]

Welcome to VR... I have the ST Jude and am well pleased with it. My warfarin dose has been 5 mg for almost 9 years. Go with your gut feeling and the advice of your cardiologist and surgeon. Remember we at VR are not doctors.

 

[T in YVR]

I agree with the others that you can't really go wrong with any of these valve mentioned, and it comes down to surgeon preference to a large extent. I have an On-X - it was my surgeon's preference - and I have no concerns with it.

One of the interesting aspects of the On-X valve that I found out after one of my first echos (and maybe some of other valves have this) is how it is designed to actually produce traces of "trivial regurgitation" across the valve. This regurg consistently shows up in my echos. At first I was concerned that I had some regurg after my new mechanical valve was put in! Well, you sort of do, but this is very "trivial" in nature and is intentional in the valve design - the regurg (as the technician described it in their report) (or backflow) is intended to essentially help reduce the risk of clots forming (there is a much more technical way to describe this I am sure - this is in layman terms ). Kind of a cool feature though.

Tony

 

[Guest]

Tony, how long have you had the On-X? Are you glad you chose it? I am now trying to decide which would be best for me. My gut tells me On-X, but my surgeon says St. Jude. He's at Stanford....a great cardiologist, but something tells me to do more homework. I'm Canadian, living/working in California. I live 2 hrs away from UCLA hospital who works with ON-X, and 4 hrs from Stanford who is 'pushing' St. Jude's. My name is Lilly.

 

[ajc1991]

I have to have a mechanical valve put in soon and in the beginning wanted the ON-X valve. But St. Jude does have a longer and successful history, I'll most likely go with that. Going to see what my surgeon thinks, I have a feeling he'll advise me to go with St. Jude too.

 

[ski girl]

+1 for everyone who says go with what your surgeon prefers. They know a lot more than you do, and you want them to do the best job possible - which is more likely with the valve they prefer to sew in place!