It makes a clicking sound

[pellicle]

I'll take it! I'd like a new handle please.

LOL

Message @Admin

 

[carolinemc]

I'm now 2.5 weeks post surgery, re-do previous tissue bentall with 29mm St Jude mechanical. I have a loud tick in my throat, and a strong thump with deep breaths, hopefully that's just things finding their place behind my lungs.

The consolation is that I can zone out from the noise when occupied and active, but i'm very easy to hear in a quiet room! I will have to learn to live with it for (hopefully) another 40 or 50 years one way or another.

Do not worry about the clicking, it will be normal and soon enough you won't hear it at all. But be glad when a cardio says they can hear it through the stethoscope. I always laugh when I get a Cadio that says that.

 

[Deepak khanka]

I’m wondering why we aren’t choosing On-x. This a good valve quite a lot quieter than st. Jude’s. Finally body dynamics , nature of surgery, surgeons skill set counts alot

 

[pellicle]

This a good valve quite a lot quieter than st. Jude’s.

you have evidence for that? (or just the makers claims)

Unlike most things claims in this area are seldom substantiated, however here is post on a study examining the claims VS the measurements of opening angles of the various valves
https://www.valvereplacement.org/threads/aortic-valve-choices.887840/page-2#post-902334
you'll note that I don't have St Jude or On-X

St Jude has something On-X doesn't - proven historical track record.

Did you see the post about how physically large On-X is vs the others?

 

[Deepak khanka]

I can only talk from my experience. I had my redo on 22/4/22. And had an onx , my INR came in range within 2 days. I am discharging today. Although I had to push for this valve because for most surgeons a mechanical valve is mechanical valve
From my research I knew that Onx would take less warfarin and I suppose we had a conversation in this forum previously. This whole thing has its + & -.
As mentioned earlier there many other factors involved. But I look forward to hearing the comments of those who have Onx

 

[Superman]

I’m wondering why we aren’t choosing On-x. This a good valve quite a lot quieter than st. Jude’s. Finally body dynamics , nature of surgery, surgeons skill set counts alot

For me, I went with St Jude the first time because On-X didn’t exist. I went with St Jude the second time because they were great for me for 19 years and they had a one piece aortic graft/valve that On-X didn’t have 12 years ago.

I wouldn’t have buyers remorse with any of the bi-leaflet mechanical valves on the market today, from a durability perspective.

My only On-X reservation is the 1.5-2 INR push. For me, with almost 32 years on Warfarin, I know I would have a hard time managing such a low, narrow range and would be paranoid about falling out of range on the low side (strokes and all). People new to Warfarin tend to be very concerned about bruises and razor nicks. I shave with a blade and never have an issue. I’ve bruised plenty and they can be pretty, but they heal. I’m also comfortable with the idea that in an emergency, a vitamin K shot can reduce INR quickly. Once a stroke happens, the damage is done and even if the clot is broken up, often times the effects are permanent. I feel like if I had an On-X, I’d be in the awkward position of arguing with my care providers about range and that can get very frustrating.

I still manage at 2.5 to 3.5 but mentally I’m pretty okay anywhere from 2-4. Below 2 would not pass my sleep at night test, but your mileage may vary. And I don’t share this to tell anyone else what they should or shouldn’t do or what they should or should not be comfortable with. I’m just answering the, “Why not On-X” question from my perspective.

 

[Deepak khanka]

For me, I went with St Jude the first time because On-X didn’t exist. I went with St Jude the second time because they were great for me for 19 years and they had a one piece aortic graft/valve that On-X didn’t have 12 years ago.

I wouldn’t have buyers remorse with any of the bi-leaflet mechanical valves on the market today, from a durability perspective.

My only On-X reservation is the 1.5-2 INR push. For me, with almost 32 years on Warfarin, I know I would have a hard time managing such a low, narrow range and would be paranoid about falling out of range on the low side (strokes and all). People new to Warfarin tend to be very concerned about bruises and razor nicks. I shave with a blade and never have an issue. I’ve bruised plenty and they can be pretty, but they heal. I’m also comfortable with the idea that in an emergency, a vitamin K shot can reduce INR quickly. Once a stroke happens, the damage is done and even if the clot is broken up, often times the effects are permanent. I feel like if I had an On-X, I’d be in the awkward position of arguing with my care providers about range and that can get very frustrating.

I still manage at 2.5 to 3.5 but mentally I’m pretty okay anywhere from 2-4. Below 2 would not pass my sleep at night test, but your mileage may vary. And I don’t share this to tell anyone else what they should or shouldn’t do or what they should or should not be comfortable with. I’m just answering the, “Why not On-X” question from my perspective.

Thank you Superman
Really appreciate this feed back, which I have saved in my notes for future reference
Today upon discharge the doctors wanted my lNR levels to be above 2. And mine was 2.4. I fully agree below 2 will put at higher risk thanks once again

 

[Deepak khanka]

you have evidence for that? (or just the makers claims)

Unlike most things claims in this area are seldom substantiated, however here is post on a study examining the claims VS the measurements of opening angles of the various valves
https://www.valvereplacement.org/threads/aortic-valve-choices.887840/page-2#post-902334
you'll note that I don't have St Jude or On-X

St Jude has something On-X doesn't - proven historical track record.

Did you see the post about how physically large On-X is vs the others?

you have evidence for that? (or just the makers claims)

Unlike most things claims in this area are seldom substantiated, however here is post on a study examining the claims VS the measurements of opening angles of the various valves
https://www.valvereplacement.org/threads/aortic-valve-choices.887840/page-2#post-902334
you'll note that I don't have St Jude or On-X

St Jude has something On-X doesn't - proven historical track record.

Did you see the post about how physically large On-X is vs the others?

Pellicle thanks for replying. I will go through the size of Onx vs others soon. Don’t mind if I get back to you if I have any questions

 

[pellicle]

I can only talk from my experience

You're experience of having both a St Jude and an On-X and finding the On-X quieter?

See this is the thing, people make statements with no actual evidence except believing what they are told. This is belief and the basis of religion. Not science. People are tribal and love to believe the first thing they hear. Tribalism has no place in this.

You make a statement that "the On-X is quieter" but have no actual data or even any studies to back it up ... your valve is quieter, that's great. Well I'm sure if you took the time to read posts over this forum you'll soon see people with the St Jude say "their valve got quiet" or "they no longer hear it".

Marketing works.

So, lets go back to your initial question: I’m wondering why we aren’t choosing On-x.

Well there is no compelling reason to select the On-X because:

• there is no compelling reason to believe their marketing ploy about reduced warfarin being a good thing
• there is no data to suggest having a fraction of a reduction in warfarin does anything
• there is no data to support its quieter

You raise that your INR was in line with requirements quickly, and you were released. This is not any thing more than an indicator of better management at the hospital you went to. INR management is basically crap in 90% of the cases I've read about (and in journals too) and I can submit a study that in 1985 a British hospital was using a method (which interestingly is similar to mine) to get INR right within 4 doses from surgery.

Strange that it is not common practice despite being published.

It is of no point now because you already made your choice and are wearing it. However because other people yet to make a decision are reading this (as you no doubt read other posts in the past) I am answering this.

Next look at size

my goodness look at the size of that thing. As @nobog (who knows his stuff) pointed out some time back "the On-X is huge" compared to other bileaflet pyrolytic carbon valves.

Does it have better dynamic profiles? Well not according to anything I've read:

https://www.sciencedirect.com/science/article/pii/S0022522319304842
so is there anything to support the On-X claims that a lower INR protocol is good for you or better for you or even safer?

The answer is no there isn't, indeed there is evidence to the contrary, as this poster here found out:

http://www.valvereplacement.org/for...e-of-onx-valve-and-problems-with-lowering-inr

Lastly I will say that when I knew nearly nothing about mechanical valves and had just a few months to make a choice I was offered:

• bio-prosthesis (but cautioned that 10 years later I'd be in line for a redo, its now 10 years later)
• an ATS valve
• an On-X valve

Back then I wrote this blog post:

https://cjeastwd.blogspot.com/2011/11/heart-of-matter.html
I would encourage you to read it, slowly and thinking about every sentence and what it implies about my level of knowledge. Now I can say that I've learned quite a lot in the following 10 years and am quite glad I got what I got.

To answer why the surgeon made his choice is simple: due to the complexity of my arch anatomy and the aneurysm there was not an On-X that had a pre-attached aortic graft (for a Bentall) that was approved in Australia at that time. So to reduce surgical time and reduce time on the cross calmp my surgeon rightly chose to put in the ATS. Why rightly?

https://pubmed.ncbi.nlm.nih.gov/20965288/
Picking a valve is and should be based on science and data, not belief or faith.

Faith is for religion and if you look at the middle east where there are multiple religions it would seem that only causes strife.

Mechanical valves are evolving as we learn more, to me its all part of the grand experiment that is life. However until you have data, and substantial evidence don't pretend what you have is the best. I sure don't

Best Wishes

 

[nobog]

Just a note about Pel's above post, "tad" = tissue annulus diameter, in other words that's the valve size. In general, that's about the middle of the cuff. The On-x is tricky because they only have 4 "carbon" sizes, a 25mm is the exact same valve as a 33mm valve, just a different cuff.

 

[pellicle]

Just a note about Pel's above post, "tad" = tissue annulus diameter,

thanks for the inputs, I always learn something.

 

[pellicle]

Deepak
sorry that I missed this bit, there was some strange quoting bits in that too btw where you apparently quoted the entire block I'd said twice with no remarks about what you'd quoted (or why).

Don’t mind if I get back to you if I have any questions

absolutely, I'm here because I do my best to answer questions which are within my grasp and sphere of knowledge. Make sure to @ mention me (the @ followed by my properly spelled user name , or just start typing my username after an @ and click the right one) if you don't reply to a post of mine (thus giving me a notification.

BTW
I wanted to make it clear that I do not believe that one pyrolytic carbon bileaflet valve is in any way significantly superior or inferior to another. To me they look like nearly identical designs converging on a common space. Indeed all studies I've read (such as the one I've posted) show nearly no differences). Thus the competition is about sales and market presence not measurable patient results as I see it.

So I am in no way saying you have a valve which is not good. I am simply responding to the primary points

1. that On-X is quieter
2. that we should all be getting On-X (something you implied when asking "I’m wondering why we aren’t choosing On-x." I took this as implying "...why aren't we all choosing ..."

if I've made any incorrect assumptions please set me straight on that.

My sister-in-law has been in pharmaceutical marketing for about 15 years and I know something of how they indoctrinate their sales staff and how they wine and dine the right people.

Also, since you mention redo and your bio does not contain you medical history in any detail can you clarify what your previous valve was, when it was put in and why a redo was required. All of that information is in my Bio and when asked (as I often am) I always provide that detail to the asker (and indeed clear up any questions about my choices and "why"

Thanks

 

[Estrazz]

I am nearly 6 months post op from my Bentall procedure with an On-X valve. The feeling of the valve in my throat is finally gone but the clicking and thumping is here to stay. I realize now that I will likely not ever be one of the people that have the noise "go away." I am aware of it 24/7. About the only time I have not been able to hear it was at an Eric Church concert in March. The noise no longer bothers me and I have had on several occasions where people ask what that noise is. It makes me wonder how many others hear it and do not say anything. The only thing that my valve has caused issues with in my day to day is counting. I can no longer count without just counting my clicks. Whatever my heart rate is, is the speed I count at!

 

[pellicle]

I realize now that I will likely not ever be one of the people that have the noise "go away."

having similar amounts of awareness of mine, and being 10 years out now, I can say that some time ago it stopped bothering me (can't say that I didn't have an active hand in that attitude adjustment) and there genuinely are times when I can't hear or feel it. Happily they're mostly on my motorbike, but doing other work too and in conversations.

Stick with it mate...

 

[Timmay]

https://en.wikipedia.org/wiki/Misophonia
Given the existence of misophonia, I would imagine that there are individuals that truly couldn't live with the clicking. I have personally witnessed individuals with mysophonia get seriously upset from the crunching of potato chips ... and that crunching was taking place in a different room .

I'm blessed to not have mysophonia. I'm also the guy with tinnitus in his ears from my hardcore music days so you'll rarely find me without music playing or a fan running or a sound machine. I love white noise. I also REALLY like watches. And when I have a loud ticker on my wrist ... it is comforting.

Here's to hoping that my love of ticking clocks carries over to my upcoming On-X

 

[pellicle]

Given the existence of misophonia

According to that link: it has yet to be considered a diagnosable condition

My personal view goes like this (summary):
The power of the mind is well recognised, but people sometimes "don't want to get better" strongly enough and will cause themselves to use that power against themselves.

Some people are survivors, others are the lay down and die type (and having been in a few survival situations I've seen both). I'm the type that even when I want to just give up some part of me won't allow that. Its irrational.

We're all different.

 

[DaveLee]

I had a St. Jude mechanical valve put in 9 months ago. It was louder for the first couple of months, but has quieted down substantially. At this point, I usually don't hear it at all. For example, it is very quiet right now and I'm trying to listen for it but can't hear it at all. However, if I take a deep breath, I can hear it for a few beats. I expect this is because the expanded lungs act as a drum of sorts. I can also hear it if I put on headphones or put earplugs in. I'm about to go hike a local mountain and I will certainly hear it some as my heart starts to beat harder with exertion.

Hang in there. As the months pass it should not be nearly as noticeable.

I must agree with Chuck C on this. I have a St Jude valve installed sept 2008. At first is was so loud it keep my wife awake. She was about ready to sleep in another room It does get better, The only time I hear it now is when I listen for it.

 

[Chuck C]

It does get better,

It's nice when things get better:

 

[ThomasM]

I'm a bit on the sensitive side, and I have never "really' gotten used to the clinking at bed time. The sound is pretty much the same today, some 35 years later, that it was right after surgery. As I sit here and write this message I can hear it clinking away, very easily. At night to relax me, I always have an air cleaner running at bedside to muffle out the noise, or I don't sleep very well.

 

[ThomasM]

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