On-X vs. St Jude Mechanical valve

[edjspi]

Hey All!

Looks like I'm headed toward my second AVR on 9/7/10. Went with a tissue valve first time (bovine), lasted 6 years, this time I'm going for the mechanical, after much discussion with my cardio and surgeon, as well as my own research. My surgeon is giving me the choice of the On-X or St Jude valve, but is suggesting the On-X. Says there are trials happening now with treating the On-X valve with Aspirin, and that they are going very favorably.

I would like to hear opinions people have on the pros and cons of both valves.....

Anyone out there with an On-X valve: likes, dislikes? are you able to hear it?

if you had a choice of the St Jude and On-X valve, why did you pick the one you did?

Or especially if you have had BOTH valves, I'd love to hear from you!

thanks in advance!
-Eddie

 

[ALCapshaw2]

You will find MANY threads discussing Valves in the Valve Selection Forum.
One thread of interest is titled "St Jude" (or St Judes" without the period).
Do an Advance Search and scroll down to find "Any Date" in the drop-down menu.

Have you looked at the manufacturer's websites?
see www.sjm.com for St. Jude and www.heartvalvechoice.com and www.onxvalves.com for On-X

Do a Search for keyword "Bokros" to learn about Jack Bokros, Ph.D. who is responsible in part or whole for the designs of ALL the Modern Bi-Leaflet Valve Designs from ATS, Carbomedics. ON-X, and St. Jude.

(BTW, It would take HOURS to duplicate all that has been written on this subject)

'AL Capshaw'

 

[edjspi]

yep... looking at the posts now. Sorry about that, i should have checked before I posted.
thanks for the tip...
-Eddie

 

[Lynlw]

I saw your post on the tissue valve thread where you wrote
"Plus I'm going with an On-X valve, hoping that somewhere down the road I will be able to reduce or replace the coumadin with aspirin to treat it."

I didn't want to hijack that thread, since you started this one asking about the ON-X, But I don't know of any current trials going on where you would be able to replace coumadin with Aspirin alone, the current US trial one leg has plavix AND aspirin for people with lower risks.
Before this trial there WAS one in Germany that had an aspirin only leg, they stopped that trial after a couple years , and when they started this bigger trial that was NOT an option.

 

[TickTick]

I just found out I'll probably need a replacement about a week ago, and will seeing my surgeon next Tuesday. Assuming he'll suggest a mechanical, I'm leaning heavily toward the On-X myself based on initial research. Real feedback from patients will be most valuable, however, as the manufacturer's web sites will obviously be biased.

 

[AgilityDog]

Well, I've got both: St Judes in mitral position (wasn't given a choice, emergent surgery, and I didn't have a chance to do any research, I just knew I wanted mechanical due to my age and to avoid re-operation on that valve)
and On-x in aortic position.

I voted for the On-x this round because of the better hemodynamics, to reduce my risk of hemolytic anemia having 2 valves. It is my surgeon's preferred aortic valve.

I will say my On-x isn't yet silent, 2 weeks after implantation, but it is much quieter than the St. Jude was at this stage...or maybe I'm just used to the little ticking. But seriously, with the St Jude, I felt like Captain Hook's crocodile, Tick Tock, for several months, until it settled in. A couple years later, I only heard the valve at specific times - in the WC, etc. Right now, the On-x has a higher pitched click, but it's quieter than the St. Jude's was. I hear it more right now, but expect it will settle down in a few months, particularly after my ICD gets re-adjusted, so I'm not running 80 bpm at rest!

 

[RobThatsMe]

Hi,

I am having my surgery in a few weeks, and will be having my existing St Judes replaced with an On-X aortic valve. My surgeon at the Cleveland Clinic said it is the only valve that he uses now. I am actually looking forward to this, as my St Judes only lasted 10 years due to pannus tissue development. The On-x valves are designed to significantly reduce the effects of pannus growth. It also allows for increased blood flow through the valve. I could come out of this surgery feeling better than I have felt in years.

Rob

 

[drivetopless]

Either valve is a good choice. I'm hoping for an On-X because so far it seems to have less of a potential for pannus growth down the road. But if I get a St. Jude Regent because of size/fit, I wouldn't be upset.

 

[nngbwh]

I really didn't have a choice. Surgeon never mention different type of valve He said get a mechanical valve or have another surgery 10+ yr from now. My surgery went so quick I didn't have time to research other valve. Good luck with surgery and keep us updated.

 

[ALCapshaw2]

Here is a summary of "Morbid Event Rates" for the primary Mechanical Valves used in the USA as reported in my earlier post in the "St Jude" thread.

---------------------------------

A few years ago, On-X sent me an 'Information Package' which included a pair of tables entitled "Morbid Event Rates Comparison" for both the Aortic and Mitral positions with footnotes indicating the source of the data for each company which included PMA (something about Safety and Effectiveness) Summaries (ATS and CMI) and FDA submissions.

The combined rates in (% per pt-year) for Thromboembolism, Thrombosis, and Hemorrhage for the

Aortic Position were

On-X = 2.14 % per pt-year
SJM = 3.90 St. Jude Medical
CMI = 2.96 Carbomedics
ATS = 4.04 ATS
MH = 2.50 Medtronic Hall (I believe that is a single leaflet valve)

Mitral Position

On-X = 1.86 % per pt-year
SJM = 3.34
CMI = 4.44
ATS = 5.07
MH = 4.30

I left off the breakdowns by categories because I'm not about to sit here and re-type all that data. Note that other factors such as Hemolysis (blood cell damage) and Pannus Tissue Growth are not included in the above statistics.
EDIT - note that ON-X is the Only Valve Manufacturer that incorporates a Barrier to retard / prevent Pannus Tissue Growth from impinging the Valve Leaflets. Also note that On-X reports Hemolysis rates comparable to Tissue Valves (50% or less compared with other mechanical valves).

The complete charts are available to ANYONE who asks for them. Just call or e-mail On-X and they will send you whatever information you request. Contact information is on their website www.onxvalves.com or 888-339-8000.

They have recently published another set of Bar Graphs which also include several tissue valves (which I find a little hard to interpret - too much information in too little space... give me the numbers in a spread sheet format please).

'AL Capshaw'

 

[ShezaGirlie]

if you had a choice of the St Jude and On-X valve, why did you pick the one you did?

I didn't have a choice and On-X wasn't around 11 years ago, BUT if I had to do it again......hands down it would be an On-X..!

 

[Lynlw]

I didn't have a choice and On-X wasn't around 11 years ago, BUT if I had to do it again......hands down it would be an On-X..!

I agree most likely I would get an ON-X for myself of family member, if getting a mech valve. But I just want to make sure it wasn't for the hopes of just needing aspirin, I don't see that happening any time soon since it isn't in trials as far as I know (Eddie, If you could ask your surgeon for any info about the trial he is talking about, I'd love to see it - from your post above (My surgeon is giving me the choice of the On-X or St Jude valve, but is suggesting the On-X. Says there are trials happening now with treating the On-X valve with Aspirin, and that they are going very favorably." )

Also my concern about hoping on /planning on the possibility of Plavix instead of coumadin, From what I've read , in studies and the FDA Blaxck box warning, about 2-14% of the people (not in the trials just people in general) can't use Plavix, well are poor metabulizers so it isn't that effective at preventing clots or strokes. Granted that is still a low amount, but if it is you, most likely plavix alone or with aspirin wouldn't be an option. I guess if you really hope to be able to some day in the future go to plavix, you could probably ask your doctor about having the testing to see if you are someone who is a good metabulizer.

But if there are other things that, so far, make ON-X one I would probably choose.

ps here is about the warning http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm204253.htm

 

[Bina]

Mine is the newest mech model from St. Jude; the Regent.
It is the very close twin to the On-X.
Supra annular positioning, great hemodynamics, and leaflets that open wider than the standard St. Jude.

 

[daveguy14]

I faced a similar situation recently (tissue at 18, reop at 25) and went with the St. Jude. For one, plavix/aspirin only is a long ways away from being a reality, and it may never happen. It might, but you're setting yourself up for disappointment if you expect to not need Coumadin in the near future. Also, do not uncritically accept data from manufacturers' websites. My rationale was that I'm so young I want a valve with demonstrated longevity. Because the St. Jude has been around so long, that's why I preferred it. I'm sure the On-X is an excellent valve with similar durability, but I felt better with the St. Jude's very long track record.

 

[ALCapshaw2]

The St. Jude Master's Series Valves have evolved from the original St. Jude Bi-Leaflet Valve introduced around 30 years ago.

I belive that the St. Jude Regent came out about 1 year AFTER the On-X Valves were introduced to the World Market.

It is my understanding that the St. Jude Regent has some improvements similar to the ON-X Aortic Valve but does NOT have a Barrier to retard Pannus Tissue Growth and is not made of the 'latest' (improved) form of Pyrolytic Carbon (patented as On-X Carbon). The St. Jude Regent Valve is only available for the Aortic Position.

'AL Capshaw'

 

[Philip B]

Choices?

Choices?

Both valves are good products. On-X has an advantage with better hemodynamics. Another advantage is that it does less damage to blood cells when it closes.

I've got a St. Jude Regent. I opted for the St. Jude because it saved me a little bit of time off the heart-lung machine. About the only advantage of the St. Jude is the availability of a factory installed conduit for those needing a aortic graft. It's a small issue as a good surgeon can do the attachment stuff very quickly.

-Philip

 

[hook]

I have a St Jude instaled three months ago; given a choice I would have gone on-x

 

[Bill B]

My surgeon had a strong preference for the St. Jude I got. It's not one of the newer valves. My surgeon said he'd install whatever I wanted. So, I took a long look at the newer valves but concluded that the proposed advantages had not been established. My work in the drug industry taught me to be very skeptical of drug and device manufacturers' claims and in-house data. I decided to trust the judgment of my surgeon.

 

[dl_mooney]

Did a lot of checking befor my surgery. I chose the OnX (Mitral Valve). Pleased with it. Believe it has several things going for it. I take Warfarin 4 Mgs daily. Surgeon wanted my INR level 2- 3. Home check with CoaguChek XS one time a week.Also less chance of blood clots on valve, & has feature to prevent tissue from growing over valve.Plus more.

 

[ARGreenMN]

Mine is the newest mech model from St. Jude; the Regent.
It is the very close twin to the On-X.
Supra annular positioning, great hemodynamics, and leaflets that open wider than the standard St. Jude.

That's my understanding too Bina. I could be wrong, but when I read things on here that talk about St. Judes in general (like Al's article above on Morbid Event Comparisons) I assume those comparisons are pertinent to the St. Judes Master series, not the newer Regent. If there are any independent studies (not from On-X or St. Judes) that compare the Regent to the On-X I'd love to see them. I've got the Regent and it's a small one (19mm) which I understand is a bit of a concern for a big guy like me (BSA about 2.5) due to increased chances of Pannus growth. So if there are independent studies that indicate I have even more of a chance of Pannus growth because I've got the Regent vs. the St. Jude, I'd like to understand that. I talked to my surgeon about On-X before surgery. He seemed to know all about both, and preferred the Regent.