On-x versus St. Jude

[rick0329]

Hi everyone. This is my first post here. I will be scheduled for an aortic valve replacement during the 1st week of September 2014. I am a 63 year old male and in good health other then this valve problem. The only other problem I had with my heart was about 1 year ago with AFIB and congenital heart failure which is under control now. I must say I am not afraid of the surgery I am actually terrified of the surgery! I have finally resigned myself that it has to be done and now I try to envision my recovery in the future. I have decided against a tissue valve for a couple of reasons: 1. I do not want to have the prospects of re-surgery on my mind. 2. I know that the major reason for getting a tissue valve is to avoid taking Coumadin for the rest of my life, however I did have AFIB about a year ago and had to be on Coumadin for 6 months. My understanding is that my chances of getting AFIB again is a good possibility so I have a good chance of needing to take Coumadin again in the future.

Because of the above 2 reason I have decided on a mechanical valve. I have researched the ST. Jude that has had over 30 years of success and the newer ON-X valve. I just found out today if I choose the new ON-X valve I will become part of a research study to determine if less or no Coumadin will be required with this valve. This worries me because there could be the possibility of stroke during this study! On the other hand if the study works then at least I would have a valve that has the potential to eliminate Coumadin in the future!

I am wondering if anybody else has had experience with the ON-X valve and if they have been part of the study group?

 

[neil]

hi rick and welcome aboard, cant help with your questions but just wanted to say the op isnt as bad as your mind makes out, you will do just fine,

 

[pellicle]

Hi Rick and welcome aboard

Because of the above 2 reason I have decided on a mechanical valve.

sounds like a well reasoned choice and your points seem logical to me. I would also say that there is an interesting view on mechanical presented by a fellow at the Mayo clinic who suggests that looking carefully at the data that there are other advantages conferred by having a mechanical on life expectancy too. Let me know if you're interested and I'll send you the link.

I would say to you also not to be too terrified about the surgery. I've done it twice as an adult (once as a kid) and its not as tough as you may think.

I have researched the ST. Jude that has had over 30 years of success and the newer ON-X valve. I just found out today if I choose the new ON-X valve I will become part of a research study

my understanding is that participation if voluntary. Your surgeon (and perhaps a cardiologist) will have the say in determining your INR targets and someone (of if you're like me, then you) will manage the drugs for that. I guess having been on it before you know the drill

Target INR is 2.5 these days for an Aortic modern mechanical.

With respect to the valves, just the other day there was a thread on this (I thought it may be you even) and the views there (including mine) were that there is functionally little difference between the top 3 valves. I also researched the On-X valve at the time they determined my valve needed replacing. I have an ATS valve which I did not even know about, but which I am quite happy to have.

On the topic of reduced anticoagulation, I would think that the targets may shrink but there is no technology available today which will convince the experts to make it zero. For good reasons too.

Best Wishes

 

[rick0329]

Thank you all for you great responses. I have a week and a couple of days to make my final choice. I am glad to hear that the surgery is not as bad as I imagine, I know about 10 year ago my dad had a hard time with bypass surgery with many complications but he was already in his 80's and had several heart attacks before his operation. So of course after seeing his complications I had concerns. This looks like a great forum and I hope to keep everyone informed of my decisions and progress.

 

[tom in MO]

The target inr for my 2 yo mechanical st jude is 2-2.5. Per my cardio, going as low as 1.7 is not reason for concern. In the US participation in any clinic trial requires patient consent.

 

[rick0329]

Glad to hear that my consent is required for the clinical trial. My thoughts are, if allowed, is to have the ON-X installed and take Coumadin like any other mechanical valve, then if it is deemed appropriate through their study to switch to lower levels or even aspirin at least I will have the ON-X valve installed. If not then it will not be any worse then any other mechanical valve. Because it is a newer valve then the ST. Jude it is not as well tested for durability. My understanding it was introduced in 1996 so it does have a good track record so far. My next step will be to try to find out the failure rate of the ON-X valve versus the ST. Jude.

 

[skeptic49]

Sounds like a good plan to go mechanical. The latest guidelines state that AVR with a mechanical valve is "reasonable" until age 70. Best wishes for a successful procedure and a speedy recovery.

 

[Heart Of The Sunrise]

I chose the ON-X. Coumadin no problem. My INR range 2.0-2.5. I am now home testing with the Cougucheck XS meter. Smooth sailing so far. Although my cardio says that the valve is so good in time maybe no Coumadin.

 

[rick0329]

I am 99% sure now I will go with the ON-X valve. It seems it is the newest technology. I have found out that the research study is done and the recommendations have been sent to the FDA, therefore I would not be part of any study. With surgery coming up next Friday (Sept 5) I will try to remain calm. I am encouraged that some of the comments here say the surgery is not as bad as one might think!

 

[rick0329]

Hi Rick and welcome aboard " I would also say that there is an interesting view on mechanical presented by a fellow at the Mayo clinic who suggests that looking carefully at the data that there are other advantages conferred by having a mechanical on life expectancy too"

I found this presentation fom the Mayo clinic and this also reenforces my decision about a mechanical valve. Thank you Pellicle for making me aware of this!