Influences For Mechanical Valve Selection

[Adam 12-21-05]

Hey everybody,

I have a quick question for those of you who have already had a mechanical valve replacement.

As you know, there are a number of different mechanical valve manufacturers and valve types.

My question is, "What factors motivated or influenced you in your decision to select one valve brand over the other?"

Any thoughts or opinions you could offer would be helpful...

Cheers,

Adam

 

[Dennis S]

I chose the "regular" St. Judes because:
1. The most extensive track record.
2. I knew my surgeon had installed hundreds of this particular valve and it would be the easiest & quickest choice for him to implant.

 

[Ross]

I didn't have a choice. Surgeon wanted to use an On-X, but he needed a graft sleeve already attached to the valve and at the time, On-X didn't make one. St.Jude did, so St. Jude it was.

Model 25CAVG-404

 

[Cooker]

I knew I was getting mechanical. I went to sleep and according to the card in my wallet woke up with a St Jude model 23AJ-501

 

[Adam 12-21-05]

I knew I was getting mechanical. I went to sleep and according to the card in my wallet woke up with a St Jude model 23AJ-501

Interesting.

So you never discussed it with your cardiologist / surgeon?

Or, maybe I just don't understand what you mean by the card in your wallet?

Cheers... Adam

 

[Rich]

Adam,
In years gone by there was no dicussion.
The valve was chosen by the surgeon, probably due to his/her comfort zone with a particular valve.
For me he did the right thing as far as I'm concerned, my St. Jude has been great.
I wasn't even given a choice as to mechanical or tissue. He said at age 58 I was too young for a tissue valve.
Rich

 

[Cooker]

Interesting.

So you never discussed it with your cardiologist / surgeon?

Or, maybe I just don't understand what you mean by the card in your wallet?

Cheers... Adam

I discussed mechanical vs tissue. My cardio said if he had my life style he would go mechcanical and the surgeon likes St Jude and would decide which one when he got in. I met my surgeon the afternoon before the morning of my surgery. I picked him on the recomendation of a nurse who had worked with him. I did not ask a bunch of questions. The cardio and surgeon are tops so I sign the papers and said lets roll

 

[Karlynn]

Left the choice up to my surgeon, but 16 years ago there weren't many selections and the St. Jude was the gold standard.

 

[Sherry]

Hi, Adam. I must concur with Rich and Karlynn: it was really left up to the surgeon, but, he and I did discuss him repairing my valve, which considering his reputation as one of the best surgeons in the state of Indiana and my naivety, I just said "Uh, okay" or whatever else shell-shocked people say when they find out they have to go under the knife. As it turns out, he worked on the repair for six hours and then it still leaked, which necessitated him putting in the "gold standard", the St. Jude's. My sister-in-law, an RN at that hospital, actually sat in on my surgery (with his blessings) and said to me that I wouldn't believe how hard he worked at the repair before giving in, which brings me back to the original point: it's what they're comfortable with and what they're faced with once they get in there.

This was 10 years ago, in the days before VR.Com and really in the days before there where many other choices. I was pretty uninformed at 33 and really just left it up to him. As it turns out, 10 years later, I feel he made the right decision. Best of luck to you in this process.

 

[dick0236]

Valve type

Valve type

I also did not participate in the decision of valve type.....but I've a "gut" fealing the choice was limited to one, ball-in-cage (Starr-Edwards). I am very grateful that I did not have to participate in this decision. I expect that I would have second guessed my decision many, many times.

 

[Lisa in Katy]

My doctor and I briefly discussed mechanical vs. tissue, but I was an easy sell. I had followed the story of Lewis Grizzard, who died shortly after his 4th tissue valve replacement, and at my age (36), I figured I would have to have at least 4 if I went tissue, and probably only 2 with mechanical. The internet wasn't quite so expansive in 1998, and I didn't even know enough to choose a brand. My surgeon chose a St. Jude and I trust him completely. Sometimes I think it's better to be in the dark about these things and let the experts choose. I didn't even know much about Coumadin, other than I'd have to be on it forever.

 

[Granbonny]

Adam

Adam

Seeing that you had a Ross..when you had your surgery..December 12, 2005..May I ask why you are posting this question?.....If it is for research for another book.....I would rather not answer to your post.........I feel like that is between me and my surgeon.....If you were Pre-surgery and wanting to know..Yes..I would post..and answer your question..Bonnie

 

[ALCapshaw2]

Many surgeons / hospitals only offer a FEW choices. A local surgeon offered me the choice between a St. Jude Mechanical and a Carpentier-Edwards Bovine Pericardial when I first learned of my Aortic Stenosis. (FWIW, that surgeon did his residency at Cleveland Clinic under Dr. Cosgrove). In the end, surgery was postponed and I later went the the Major Heart Hospital (University) in my state. The surgeon there agreed to a Bovine Pericardial Valve UNTIL he got in there and implanted a Standard St. Jude due to Radiation Damage. It was the right decision.

I have been told that some of the BIG Hospitals ask for BIDS from all the suppliers and pick TWO Mechanicals and TWO Tissue Valves. I expect that Most surgeons won't go against their hospital's choices. This may be changing SLOWLY as patients become more educated and begin requesting specific Valves (that may be outside the 'standard hospital offerings').

'AL Capshaw'

 

[tcopel]

After initially finding my aneursym and aortic valve insufficiency, my cardiologist simply said in a matter of fact fashion that I needed a St Jude. I went to visit with a surgeon who also said that was indicated. It wasnt until I researched options on my own that I became aware of other possibilities (repair, tissue, onx). With the good help of those here on VR as well as other resources including people that I've known in my personal life with different types of valves, I began to sort out what I would like given my circumstances. Of course, lifestyle and anticoagulation and reoperations percentages, and my age of 52 played a part in it. From the posts I've seen to date, it seems that is the way the majority of people are recommended certain valve types by their docs as mine did.
Given a choice between tissue and mechanical (and what type of mechanical), what influences did I find swaying me? I think anticoagulation was a factor for me. I know that the vast majority of people do great on coumadin and it does NOT impact their life whatsoever...but for me individually, it was a thought that bothered me for some reason. I dont know why. Gambling on the hope that technology will help in developing less invasive ways to repair or reinsert valves in the future, is considered by some, to be crazy but it is a hope nonetheless. Dont know if this rambling helped or not.

 

[sue943]

It didn't even occur to me that there was a choice, or a difference in valves. The evening before my surgery the surgeon asked if I wanted mechanical or tissue and as I was 57 I said I supposed I ought to have mechanical so as to avoid re-operation when I was seventy. I told him that I cannot bear to have a ticking clock in my bedroom and he pulled a face (nicely), I woke up with a couple of ATS valves.

Had I known about a choice I think I still would leave it to my surgeon, I trusted him to do the best for me and to bring me safely through the other side.

 

[dtread]

Valve Choice

Valve Choice

I decided to go Mechanical due to my feeling that the Biologicals had limited life, and I did not want to have the threat of reoperation hanging over my head. Also, I did not want to have possible degraded performance that Biologicals might have in the later years of their life. Of course, the big drawback with Mechanicals is the anticoagulant, but I did not view that as a major obstacle. The facility where I was going to have my surgery used St Jude. I checked websites for St Jude, and the St Jude valve is impressive. Then, for my own education, I checked out the competitors on the Internet. I ruled all the competitors out for various reasons except for On-X. I researched On-X website extensively and compared it to St Jude. I decided that On-X was a better option for me. Some of this was my feeling that On-X has better engineering, some of it was just gut feeling. I was not acquainted with Valvereplacement.com at this point, so none of my decision was based on conversation with any other valve recipients. I had to schedule an appointment with my surgeon, and he was at first very reluctant to consider the On-X. I persisted, and he finally indicated that he would research it but would not guarantee that he would use On-X. This was good enough for me, as I felt that the St Jude was certainly a very good option. As it turned out, I got an On-X; i.e, the first On-X used at the facility where I got my valve. I had contacted On-X for some additional information on valve hemodynamics, which they provided. I did not contact St Jude as I did not need any additional information from them. So, to answer your question: I was influenced regarding valve choice almost entirely from Internet browsing of valve manufacturer's websites.

 

[Blanche]

Adam
I have seen you checking this thread and I wonder if you are going to answer Granbonny's question. Is your question one of honest curiosity or is this question geared to gain information for your next book, or a second edition of your first book?

I have noticed that some of your posts seem to be asking questions that might be geared to interests other than your own unselfish curiosity. Are you using this site to mine for materials for your next book or the second edition of your current one?

Your answers to these and Granbonny's questions are egarly awaited.

With the kindest regards,

Blanche

 

[catwoman]

I preferred a Mercedes, but Daimler-Benz didn't make heart valves.

Seriously, I agree with Granbonny & Blanche. What is the nature of your curiosity about this, since you had a Ross in December 2005? Has the Ross gone south and are you facing a re-op?

 

[greg]

I had read a little on valve types but not to much. Never discussed it with cardio but did with surgeon. He recommended I go with St. Judes due to track record and my age. I agreed. Coumadin was never a consideration. It still isn't. I hope it never is.

 

[Adam 12-21-05]

Thanks everybody for your responses! Really, really, really interesting ideas, thoughts and experiences.

Since I had the Ross Procedure done, I didn't have a mechanical valve inserted. That said, the other day I was wondering, "How would one go about choosing one valve brand over the other."

I knew that specifications would partly impact the decision but I wanted to learn more.

I guessed y'all might have some ideas. Well... Ding! Ding! Ding!

I also thought the post might help others that are viewing this site as guests.

So, I was just curious. (My Ross is holding up very well.)

It appears that selecting a valve can be both a personal and impersonal process... Much, much different than buying a car or a technically advanced computer. Less choices. More concentrated influence (e.g. surgeons and cardiologists).

However, as many of you alluded, that appears to be changing given the efforts of many valve manufacturers and, of course, sites like VR.com.

That was really neat to learn about in your posts... The nature of "online patient-to-patient relationships" and how that can influence (stimulate or detur) mechanical valve selection.

Again, thanks for sharing!

Cheers,

Adam