Mr. Magoo thinks that valve choice should be left to the surgeon. Pick a good surgeon, and then let the surgeon decide the valve. The implication is that the “Valve Selection” forum should be changed to “Surgeon Selection”. Pick a good surgeon, who has completed at least two dozen implants of whatever valve he/she decides to use, and you’ll do okay.
I do not agree with this very conservative and quite passive position. If I did I would not have an On-X valve; I would have a St Jude.
When I became aware that I would be having a valve replacement, I only had a few weeks prior to the surgery to prepare. I was told I would be getting a St Jude valve. I went onto the Internet and went to each and every valve manufacturer’s website to see what they had; to compare with St Jude to see if they had anything that would make them a better choice than St Jude. I specifically performed my research being aware that the websites would be using marketing strategies to promote their product, and to try to “read between the lines” so to speak.
I ruled out the Medtronic Hall Easy-Fit Valve because I do not like the tilting disc design. I ruled out the ATS Open Pivot and Carbomedics bileaflet valves simply because they did not seem significantly different than the St Jude. However, when I got to the On-X website, I thought that it looked pretty interesting.
I have a Master’s degree in Marketing, and in my work in telecommunications I have dealt with many sales people and marketing strategies. I continued researching over a period of several days, specifically gathering information on St Jude and On-X. It was easy to see that St Jude is like the General Motors of heart valves, and that On-X was much smaller. However, when I looked at the data, and the other advantages of the On-X, it seemed to have many advantages; e.g.:
Lowest rate of thromboembolism
Lowest mortality rate
Highly polished hinge pivot area for less chance for clots to form
Leaflet guards to prevent pannus ingrowth
I contacted On-X to get additional information on the hemodynamics of their valve. I was particularly interested in this aspect because I have always been a fitness buff, and I wanted the best valve available so that I would have the least impairment to my fitness regimen. On-X provided me with additional information that confirmed that the On-X had hemodynamics that were at least as good, if not better than the St Jude, and with a lower mortality rate. I learned that the same person (Dr. Jack Bokros) worked on the design of the St Jude, Carbomedics, and ATS valves, and also designed the On-X. I realized that the On-X represents the latest technology in heart valves. I was sold on the On-X.
At my appointment with the surgeon I indicated to him that I wanted the On-X. At first he totally dismissed the notion, but I persisted and he finally agreed to take a look at it. He asked if I was ready to be the first, and I indicated that I was. I was willing to accept what I considered to be a pretty low risk. Right or wrong, I was going to have to live with this decision, but I wanted the best valve available. In the following days On-X contacted the surgeon on my behalf (and with my approval) and got everything set up, and sent a representative in who was present during the surgery to assist the surgeon. The day after the surgery the surgeon indicated to me that the surgery “went perfect”. I did not specifically ask him whether he had any difficulty with the implant, and he did not indicate anything unusual.
I considered being the first to receive the On-X to be low risk for a couple of reasons. For one, all the valves are pretty similar in design and implantation of one valve is not all that different than implantation of another. For another, surgeons are trained to adapt and think on their feet in stressful situations, and I do not think that implanting a new valve (to the surgeon) would add much risk to the equation. Mr. Magoo indicates a “cutoff of at least 2 dozen cases” before he would want a surgeon to implant a particular valve. This indicates to me that Mr. Magoo must have either a financial or some other interest in either ATS, Carbomedics, or St Jude. If you can believe Mr. Magoo from the “USA”, it is indicated that “in a past life I spent a couple of decades in the heart valve business”. Well, perhaps Mr. Magoo owns stock in ATS, Carbomedics, or St Jude. Or perhaps Mr. Magoo has some ties to one of these companies, is friends with present employees, or has some other relationship that ties Mr. Magoo to one of these companies. The reason I say this is that if Mr. Magoo can get future valve recipients to listen to his/her message of “let the surgeon pick the valve” and “cutoff of at least 2 dozen cases” Mr. Magoo can at least slow up, or block On-X sales. And letting the surgeon pick the valve allows sales of ATS, Carbomedics, and St Jude to continue as they have in the past. For all we know Mr. Magoo is presently in sales or marketing for ATS, Carbomedics, or St Jude, and this is simply part of his/her job. Or perhaps Mr. Magoo got snubbed in some way when On-X was formed, and has some grudge against On-X.
I believe that the way it works in most cases is that the hospital or medical center has contracts with specific medical suppliers for goods. I do not believe that most medical centers have a stock of valves on hand from Medtronics, ATS, Carbomedics, On-X, and St Jude, and the surgeon makes a decision that “I think I’ll use an ATS on Mr. Smith, and a Carbomedics on Mrs. Jones, and an On-X on Mr. Taylor”, etc. The valve choice has already been decided long ago through the contract that the medical center or hospital has, and the surgeon pretty much uses the same valve on whoever comes through for surgery. I am sure that the Chief of Cardiology had a major influence on the decision on what valve company got the contract, or it may have been decided by whoever was the low bidder, or there may have been other factors.
Subsequent to my surgery over a year ago I believe that my decision to go with the On-X valve was a wise choice. At one-year post op I was virtually 100% recovered from the surgery. My workouts in the gym (twice a week) consist of a half an hour on the weight machines (chins, dips, curls, tricep press, bench press, overhead press, butterfly, lat pull down, leg extension, abdominals, leg curl, etc.), then 15 minutes on the Concept 2 rowing machine, then 15 minutes jogging on the treadmill, and ending with 30 minutes on the elliptical machine (1.5 hours total workout). On top of that I do an 18-mile loop on my bicycle twice a week, which takes just over an hour each time. I wear a heart rate monitor, and my heart rate during workouts is usually between 140 to 165 bpm. The highest I’ve taken it to is 176 bpm for a short period on an uphill. The On-X valve has performed flawlessly in all cases. My times for the 18-mile loop on the bicycle are consistently equal to the best times I had pre-op.
Regarding the anticoagulation issue, with me it became practically a non-issue once I got on home monitoring. The side effects of the Warfarin are practically nil, and the monitoring is definitely no big deal. I do take great comfort in knowing that the On-X valve has the lowest rate of thromboembolism, and in the knowledge that there are a whole bunch of folks in Africa and Australia that have been (and are still) running around with NO anticoagulation at all. I believe that provides me with at least an extra margin of safety.
The “Articles” tab on the VR.com home page and the PTINR.com tab at the top of the VR.com forum page both take you to the Heart Valve tab of the PTINR.com website. This puts “Carbomedics” right in your face. Does this mean that Carbomedics is subsidising VR.com? This has been there as long as I can remember, but I’ve only been a member a little over a year. I don’t know that anyone raised any fuss over that, and Mr. Magoo did not mention it.
I am not an employee of any valve or medical company, do not work in the medical field, did not receive any coaching and am not receiving any compensation whatsoever for the above commentary, and do not own any stock or other interest in any heart valve company or medical concern. The above comments are not to be construed as any kind of medical advice and simply reflect my own opinions and experiences. Anybody that wants proof that I had valve replacement is free to come to the Washington, DC area and I will be happy to show them my scar and the hospital bills as proof. I also have some pictures from when I was in the hospital.
I have one question for Mr. Magoo, which I don’t think that he/she will be able to answer:
Is Lisa in Katy going to get her Massage from the Founder?
