Help with LA doctors and those with ON-X & St Judes come on in - questions for you.

[Sash]

Help with LA doctors and those with ON-X & St Judes come on in - questions for you.

First off, I was extremely worried when the doctor dropped the surgery word. Through this site and the help of doctors I am much less *worried* about AVR.

Currently I am facing two issues, valve manufacturer, and doctor in the LA area. A little about me, I am 33year old with moderate/severe AS, REGURG and enlarged heart. Last month I contracted Endocarditis through a dentist (at the time I was still unaware about weak valve) you can read a little about it here.

I narrowed down that I want a mechanical valve and to have it operated by either Dr Laks (UCLA) or Dr Starnes (USC).

I met Dr Starnes yesterday, he was confident about the procedure with a median sternotomy (4inches) but prefers St Jude's over ON-X. I asked if he did a procedures with ON-X, he said no, but he mentioned that he can get it. Personally I didn't want to be the first one since he already prefers the St Judes.

Tomorrow I will meet with Dr Laks and he from my understanding does both mechanical valves - St Judes & ON-X.

I have heard great things about the ON-X, its quieter, newer technology and hopes of perhaps the opportunity of taking a lower dosage of blood thinners.

Please let me know your thoughts, my brain is fried from all the information, and I am worried that I may make a non preferable long term decision.

Thanks for reading,

Sash

 

[Heart Of The Sunrise]

I have done my research and I favor the ON-X with the Aortic Graft. My surgeon has done these. I meet with him for the first time on February 5th.

 

[newmitral]

my brain is fried from all the information, and I am worried that I may make a non preferable long term decision

Hello Sashin,

First, I want to say that there is really no wrong decision, and either valve would likely be a fine choice.

I have an On-X valve. Because my surgery was an emergency valve replacement as a result of endocarditis, with no prior heart issues, I did not have any time to research either the valves or the surgeons in advance. I did not even meet my surgeon until after the operation was over. I picked mechanical over tissue because at the time I was almost dead and my only thought was that I didn't want to have to face another heart operation in the future.

Fortunately for me, the surgeon I happened to be assigned to chose the On-X valve for me. All my research after the fact leads me to feel that this was the best choice he could have made, and is likely the one I would have made myself if I had known what I know now.

That said, since in your case you do have a choice of hospitals and surgeons, I would go with the surgeon you feel more comfortable with, and let him pick the valve he prefers for your particular situation. You mention that the first doctor, Dr Starnes, prefers the St. Jude valve. Presumably, he told you why he prefers that valve, but evidently it was not a persuasive reason or you wouldn't be asking here.

I do agree that I wouldn't want to be the first patient on which a surgeon installed a new, unfamiliar brand of valve. Just as I wouldn't take a Toyota to a Ford dealership for repair, even though they might do a good job, I would assume that each surgeon prefers to use the valve he knows the most about and has worked with the most.

The noise of the On-X valve is pretty minimal. I would liken it to wearing an old mechanical wrist watch - you hear the ticking if the room is extremely quiet and there is no other noise, but in most environments I don't even hear it at all. It is certainly not a problem. I don't know if it being a mitral valve rather than an aortic valve has any impact on the noise or not. I also don't know if the St. Jude valve would be any louder or not.

Yes, On-X is performing trials on potentially lowering the target INR for their valve. Frankly, warfarin is no big deal, and managing your INR with a reduced target of 2.0 versus 2.5 +/- 0.5 (or even 1.75 +/- 0.25) won't make much difference in your daily life either.

Don't anguish over the choice too much, either way you will be better off than you are now. The choice of hospital and surgeon are probably much more important to the outcome than the specific valve being implanted.

 

[Sash]

I have done my research and I favor the ON-X with the Aortic Graft. My surgeon has done these. I meet with him for the first time on February 5th.

Good to know. What convinced you on the ON-X?

From research it looks as if the ON-X requires additional time on the H/L machine. Is this true?

Don't anguish over the choice too much, either way you will be better off than you are now. The choice of hospital and surgeon are probably much more important to the outcome than the specific valve being implanted.

Great info, thanks for your reply - you are 100% right.

 

[DanielB]

I agree with newmitral's post above. I had an On-x aortic valve installed in Oct. of 2011 and I have been happy with it so far. I can't compare the sound level to a St Judes, but I only notice it every now and then and my wife doesn't notice it all anymore. Those who do hear it assume it is a watch until I point it out. Your comment about the On-X requiring one to be on the H/L machine longer is new to me. I was on it about an hour and I know another person here in San Diego who said he was only on it for 45 minutes. My guess would be that this would be more of a surgeon's skill aspect of the surgery. All will be different to some measure, as things are handled as they come up in the surgery, but I would think in the long view, the time spent would even out for a surgeon. That leads to the surgeon wanting to use the St. Jude valve. He is familiar with it and one would think he would be the most comfortable putting it in. I'm sure some St. Jude folks will be along, but I do believe those valve are very similar to the On-x performance wise (some say even better). What the On-X brings to the table is the hope that thier clinical trials will allow stopping of the warfarin in the future. I would expect that the same ruling for the St. Jude valve would follow, but I choose to make decisions on things that are here now and take things like that IF they happen.

Ultimately, for me, having my life in the hands of a skilled surgeon was the most important factor as I thought both valves are good choices. In my case, the surgeon I felt the best with also preferred the On-x, so that was the final factor for my decision.

 

[metronome]

Great replies all around. I also had emergency surgery. Met Dr. Cook the night before. No time for valve options. Mitral valve, 70% regurg.
Both valves are obviously bi-leaflet. St. Jude design does have a longer history. I have one. The sound factor is something that will become irrelevent. I think either choice is good and like previous posters said, the surgeon and hospital are very important considerations.
An aside, I asked Dr. Allan Cook, pointedly, if he was any good. Standing there in scrubs and cowboy boots he answered, when you get to this level, all cardio-thoracic surgeons are good. I knew I was in good hands.
You will know which surgeon is right for you.
Have a safe journey Sash
P.S. self test at home, best money you'll ever spend