Mechanical Aorta Valve / Anticoagulants

[Todd]

Hello All,

I am up for my 3rd Aorta valve replacement and 4th OHS and will be choosing to go mechanical at 61 because I just cannot go through this any longer with tissue valves, they just do not last.

My question to folks with experience who have the ON-X valve and running a lower INR as the manufacture suggests or is this just marketing, looking for real life experience.

The hospital here in upstate NY uses the St Jude and not the on-x. I don’t have any issues with St Jude and would never know the difference once implanted however, just the thought of the possibility taking less warfarin sounds attractive and plus the Proact-XA trial testing with Elequis, sounds interesting.

My diet is whole food plant based with many leafy greens and vegetables on a daily basis!

Thank you- Todd

 

[3mm]

I have an On-X aortic valve. I keep my INR around 2.5. My cardiologist and I do not see any advantage to routinely being in the 1.5-2.0 range. I treat that range as an extra safety margin when, for example, I had pneumonia, and my INR dropped as I tried to balance changes in body chemistry, antibiotics, food, etc.

The best mechanical valve is the valve your surgeon is most comfortable with because you will spend less time on the bypass machine. There is an inverse relationship between time on bypass and successful surgery outcomes.

My diet is whole food plant based with many leafy greens and vegetables on a daily basis

This is compatible with Warfarin if you are attentive to your INR and your diet's impact on your INR. For example, if you consume 0 leafy greens one week, and then the following week you try to make up for that by eating large spinach salads every day, then you may need to adjust your Warfarin dose to match your increased consumption of vitamin k. I eat 6 servings of cooked vegetables every day and my INR stays very stable.

@pellicle on this forum has lots of information about INR management and a wonderful spreadsheet template that helps your INR management. Search on him to find educational threads.

 

[pellicle]

Good morning Todd and welcome

I am up for my 3rd Aorta valve replacement and 4th OHS and will be choosing to go mechanical at 61 because I just cannot go through this any longer with tissue valves, they just do not last.

As well as anyone can I understand the dilemma. My own history (here) begins young and my last OHS was Nov 2011.

My question to folks with experience who have the ON-X valve and running a lower INR as the manufacture suggests or is this just marketing, looking for real life experience.

Firstly let me say that while "real experiences" can be valuable there is also care needed in comparing that experience to you. I can talk of my own experiences but they may not transfer in any way predicting anything to you.

So let me just say; please read this post in this thread (perhaps these threads
https://www.valvereplacement.org/threads/on-x-low-inr-target.889739/post-936152 and https://www.valvereplacement.org/threads/on-x-and-lower-inr-protocol.863445/page-4#post-932581 )

I am 7 years with my Mosaic in the Aorta position and we are just about out of time... 6 months ago I had an echo and at that time it was 0.6cm… 2 weeks later I went in for a cath and the numbers were 1.2cm !

to me this seems like you may have high Lp(a) levels as this is quite a significant factor in rapid onset of Structural Valve Degredation in bioprostheses.

My advice would be:

1. get a mechanical; I can not say kind things about the On-X for the simple reason of their misleading marketing makes me wonder about everything else. This is yet another example of their "marketing claims" vs the actual measurements and tests of reality. See this post: https://www.valvereplacement.org/threads/aortic-valve-choices.887840/page-2#post-902334
2. The lower INR protocol is both pointless and meaningless; to my mind it is aimed at people who are suffering from a hysteria about warfarin and the fire is fuelled by the medical system which has almost entirely ignored the actual research data for over 30 years

I myself have an ATS valve, but I would steer you towards the St Jude.

Best Wishes

 

[SatoriFound]

Hello All,

I am up for my 3rd Aorta valve replacement and 4th OHS and will be choosing to go mechanical at 61 because I just cannot go through this any longer with tissue valves, they just do not last.

My question to folks with experience who have the ON-X valve and running a lower INR as the manufacture suggests or is this just marketing, looking for real life experience.

The hospital here in upstate NY uses the St Jude and not the on-x. I don’t have any issues with St Jude and would never know the difference once implanted however, just the thought of the possibility taking less warfarin sounds attractive and plus the Proact-XA trial testing with Elequis, sounds interesting.

My diet is whole food plant based with many leafy greens and vegetables on a daily basis!

Thank you- Todd

I believe that Pellicus has posted studies that show that the On-X has a higher rate of events when the lower inr level is actually used. My husband got the St. Judes because his surgeon worked with those most often. His surgeon stated the only reason that On-X can market the lower required inr level is because they have paid for the studies. He stated they needed a way to break into the market and differentiate themselves from the St. Judes. I would say On-X and St. Judes are pretty comparable in quality/safety and you can't go wrong with either of them. I would, personally, choose to keep my inr higher than 2 after reading much literature. I am pushing to have my hubby kept at the higher side of the 2-3 range with his St. Judes. His chances of getting having an accident in his life that would make a bleeding event an actual risk are very low. A stroke however would be devastating. We both very much agree that our level of brain function is very important to us in terms of who we are.

 

[pellicle]

I would, personally, choose to keep my inr higher than 2 after reading much literature. I am pushing to have my hubby kept at the higher side of the 2-3 range with his St. Judes.

worth reiterating and underscoring

 

[Beach77]

I got my On-X 5 days before my 65th birthday in Dec. 2020. My surgeon was part of the study that was researching the lower range but I declined to participate. My cardiologist agreed that was probably a good call. Since then, the study was stopped early. I like my INR at 2.5 but the clinic I go to was keeping me at 2. My range at that time was 2 to 3. Since they wouldn't cooperate with me
, I asked my doctor to move my range to 2.5 to 3. He did, and I'm very happy with that! Warfarin hasn't been the monster I thought it would be. Takes a few weeks to get a handle on it and then it's fine.