On-X Valve and On-X Valve Graft Recipients

[Heart Of The Sunrise]

I am looking for feedback from forum members who are recipients of the ON-X AVR and/or the ON-X AVR/ Aortic Graft combined unit?
I am in need of both procedures.

I had my follow-up to 12/4's cath and TEE with my cardio this past week. We discussed likely scenarios that my surgeon will present for discussion and decision.

I have my formal introductory consultation appt. with surgeon in late February(possibly sooner). I know my surgeon implants the ON-X Aortic Valve and has also performed the combined On-X valve and aortic graft procedure. I have done my research and feel comfortable and hopeful that this is the direction my surgeon feels we should go. Tell me about your new life with the ON-X Valve!

Has there been a dramatic change in how you feel as you recooperate from surgery? Can you hear your new valve? What does it sound like?
Were you aware of the ON-X or did your surgeon present it as a good option?
How are you doing with your need for Warfarin?

Thanks, Here is to the good Heart Health of all forum members and especially to those in the future who will derive knowledge and comfort from our first hand experience dealing with heart surgery and recovery.

Heart of the Sunrise

 

[pellicle]

Hi

I am looking for feedback from forum members who are recipients of the ON-X AVR and/or the ON-X AVR/ Aortic Graft combined unit?
I am in need of both procedures.

I know you asked about the ON-X and that I had the ATS, but I had an Aortic Valve and aortic graft inserted. So this may not be directly related to your question, but should be quite close.

Tell me about your new life with the ON-X Valve!

well, its life going on rather than death not going on (or going on somewhere else).

There is a noticable deep base thump from the valve, rather than a higher sounding 'click'. A friend in a quiet room once noticed it and had thought it was a car stereo in the distance.

Has there been a dramatic change in how you feel as you recooperate from surgery?

As I understood it, the reason for the aortic graft is that it speeds up operation time and means that the surgeon does not have to stitch as many surfaces together. This should not impact on recovery time in any other way other than a shorter operation time.

Were you aware of the ON-X or did your surgeon present it has a good option?

research of my own. My surgeon was inclined towards the ATS from the start, my research revealed a number of things, but as more came to light post surgery I am less concerned about the differences between the ATS and the On-X

I put a little of my research findings about the On-X valve on my blog:
http://cjeastwd.blogspot.com.au/2011/11/heart-of-matter.html

but subsequently found some other interesting points in this article
http://www.bme.sunysb.edu/labs/dbluestein/pdf/dumont_2007_comparison_bileaflet_mhvs_cfd_fsi.pdf

again that is not about the On-X but about the St Jude vs ATS, the important points are the discussion of platelet formation:

The different flow patterns affect the shear stress and platelet stress accumulation rates.

...As this flow phase was previously implicated in high levels of platelet activation, it indicates that overall, the ATS valve may offer a lower thrombogenic potential owing to its different hinge mechanism design. While a relatively small number of the platelets are exposed to these higher activation levels.

I suggest you give it a quick read.

How are you doing with your need for Warfarin?

well actually, but of course its early days. Ask me (or others) after more than 20 years on the stuff. Thats when the issues are significant.

if you were asking with respect to the different types of procedures (pre-stitched aortic graft or done during surgery) I don't think it makes any significant difference. I understood it was the contact with the valve materials (mainly alleviated by the pyrolytic carbon materials in ATX or On-X) and the hydraulics of valve open / close and pressures generated there.

Hope that helps somewhat

 

[Tell-Tale Heart]

I got a new on-X aortic valve seven months ago. My recovery, so far, has been relatively non-eventful and I am feeling well. I do not hear my valve often. Only when laying on my stomach and occasionally after exercise. The sound is more of a thunk than a click.
The warfarin is a bigger deal for me, although I'm learning to live with it. I miss eating broccoli and other greens. My system is really sensitive to these vegi's and my INR plummets after eating even a small serving. So I don't.
Warfarin is reality for anyone with a mechanical valve, not just on-x.

 

[pellicle]

I miss eating broccoli and other greens. My system is really sensitive to these vegi's and my INR plummets after eating even a small serving. So I don't.

do you home test? do you know by how much it alters INR? If you can measure it, you could alter your dose to compensate (or just take a bit of grapefruit juice with your warfarin to do that too).

 

[yotphix]

Tell Tale, I definitely understand your reluctance to muck with a stable INR but there are so many benefits to eating green foods that it might well be worth your while to work the greens into your diet, and then learn to dose the diet you prefer to eat. For me, returning to normal life post surgery meant returning to a very 'green' diet, rich in spinach, kale, broccoli, soy and and much else with plenty of vitamin K. That is surely a part of the reason I need to take 11mg of Warfarin every single day. No matter, 10mg pills don't really cost more than 1mg pills so it's just a matter of learning what the dose is that will accommodate your own diet.

 

[TheGymGuy]

Tell Tale, I definitely understand your reluctance to muck with a stable INR but there are so many benefits to eating green foods that it might well be worth your while to work the greens into your diet, and then learn to dose the diet you prefer to eat. For me, returning to normal life post surgery meant returning to a very 'green' diet, rich in spinach, kale, broccoli, soy and and much else with plenty of vitamin K. That is surely a part of the reason I need to take 11mg of Warfarin every single day. No matter, 10mg pills don't really cost more than 1mg pills so it's just a matter of learning what the dose is that will accommodate your own diet.

Speaking the truth brother!! The best thing you can do for your INR is to top off you Vit. K stores and keep them topped off. After that small-medium "greens" variations do not change your INR much.

There are plenty of studies that show that people that abstain from any greenery whatsoever and then take some in at random intervals experience largest INR spikes as opposed to those that have consistent K intake with small/medium variations. I posted a bunch of Vit. K studies in the anti-coagulation forum for your perusal

 

[pellicle]

I posted a bunch of Vit. K studies in the anti-coagulation forum for your perusal

I had a quick look, but didn't see them. Could you drop a link in here please

 

[JiFaire]

I had a quick look, but didn't see them. Could you drop a link in here please

x2, please. I like what you said about the benefits of a healthy diet, and it seems to me that avoiding Vitamin K-rich foods cold cause more issues than it solves.

My surgeon told me - "The key is to use Moderation in all things - even moderation"

 

[Guest]

I miss eating broccoli and other greens. My system is really sensitive to these vegi's and my INR plummets after eating even a small serving. So I don't.
Warfarin is reality for anyone with a mechanical valve, not just on-x.

The studies for the ONX valve should be out in the next two years, the goal of ONX is to reduce the INR, therefore, reduce your coumadin doseage, mine has been stable since my surgery, 40 mg a week, 5 days at 5mg, two at 7.5 mg. I eat broccoli, spinach, salads. The mantra is dose the diet, adjust your coumadin so that you can enjoy the foods you like.

ONX Clinical Trials, this is GOOD NEWS:
Keep up with the trials, when I had my surgery they were saying reduced coagulation by 2015.

 

[TheGymGuy]

Here are some helpful links for you guys. Be prepared to spend next 3 hours reading

1. My and others research links combined into 1 document: http://www.valvereplacement.org/for...K-Supplementation-and-Anticoagulation-Control
2. A Poll I started: http://www.valvereplacement.org/forums/showthread.php?40686-How-much-Vitamin-K-do-you-consume
3. Discussion on reaction time of Vit. K: http://www.valvereplacement.org/forums/showthread.php?40839-Reaction-time-of-Vitamin-K

FYI, Most studies that I found were less than 200mcg per day to keep Vit K stores topped off for a more stable INR. I, myself, have been taking 80mcg in the AM and 80mcg 12 hours later in the PM daily.

 

[pellicle]

Thanks mate. Somehow found the other thread in anti coagulation too.

Have evernoted it

 

[dtread]

Heart of The Sunrise, cannot speak to a graft but did get On-X valve in 2007. Works great; almost as good as natural valve. I've had it over 170 beats per minute with heavy cardiovascular exercise and it works fine. At my last checkup with my Cardiologist he was raving about my valve. He said that out of all his patients my results were the closest to natural valves that he has seen (this may be due in large part to the fact that I do a lot of cardiovascular exercise). The valve is not noisy at all. Just a quiet tapping that I can only hear if I'm in a very quiet environment. The Warfarin has not been an issue. Recommend get a home tester and do your own testing; much simpler, faster, and more patient-controllable than clinic testing. Recommend that you do not modify your diet around Warfarin; avoiding greens is not necessary. Good luck!

 

[Oilman]

Heart of Sunshine,

I too just had a On-X and aorta graft installed 25 days ago, so still in the healing process, I can't comment on the performance as of yet, but can tell you for sure that it is working better than the valve it replaced. I am just getting used to the tapping noise myself, my wife and I are such quiet sleepers so I tend to listen to it mostly at bed time, or like Dan mentioned a very quiet environment. I'm not sure if the Graf helps amplify the tap/click in anyway, but I'm sure I will get used to it over time. It was easy for me to choose the ON-X valve with the Proact study in trails and just reading the ON-X website on some of the features it offers. I know other valves offer some of the same and preform just as well, I kept in mind that every person is unique and their choices are too. I read a lot of info from members in making my choice, but the best choice of all was getting that old valve out before it causes more damage. Good luck with your choices and journey, as I'm sure you will do just fine.

Doug