on-x vs. st. jude

[cpt228]

st jude or on-x

st jude or on-x

I am a 50 yr old NYC fireman. I had avr in nov 05. If i was given the choice or knew of ,the on-x would have been my choice. My oper went great.I was walking next day and now @ about 90%.I walk/slow jog 3 1/2 miles 2-3 times a week. 1 reason I would have chosen the on-x is that with no coumadin I would have been able to return to work full duty. after 3 weeks on warifin I had an allergic reaction, fortunately i was switched to coumadin and everything is fine. I live in Staten Island NY and the local hospital has 2 coumadin ctrs. I'm in and out in 20 min with my inr levels and my coumadin dosage till next visit. Nurse practitioners do the testing and write prescriptions.This makes being on coumadin a lot easier.

Good Luck

 

[Randy & Robyn]

I am a 50 yr old NYC fireman. I had avr in nov 05. If i was given the choice or knew of ,the on-x would have been my choice. My oper went great.I was walking next day and now @ about 90%.I walk/slow jog 3 1/2 miles 2-3 times a week. 1 reason I would have chosen the on-x is that with no coumadin I would have been able to return to work full duty. after 3 weeks on warifin I had an allergic reaction, fortunately i was switched to coumadin and everything is fine. I live in Staten Island NY and the local hospital has 2 coumadin ctrs. I'm in and out in 20 min with my inr levels and my coumadin dosage till next visit. Nurse practitioners do the testing and write prescriptions.This makes being on coumadin a lot easier.

Good Luck

Welcome to our forum. I'm very glad your surgery went well. I've been through it once and will be doing it again next month. Don't worry over not getting the On-X. All of the latest bileaflet mechanical valves have great track records. The On-X is the latest and hasn't been followed as long as the others so it might be better but that has yet to be proven. Some of us on this forum like to follow all the latest developments and make our own predictions since the issues are so close to our hearts

If you have any questions about your coumadin management you can certainly find all the answers here as well.

I take it you now have an office job due to your coumadin therapy. It's unfortunate but happens quite frequently to people in high risk professions who find themselves on anticoagulants.

Allergic reactions to warfarin are rare. Was it the coating they use? That makes sense since coumadin and warfarin are basically the same drug.

Have you looked into home testing yet?

Good luck in your continued recovery.

Randy

 

[Karlynn]

Welcome Cpt.!

I wouldn't feel too cheated at not getting the On-X right now, as far as your work status. I think it is going to be quite awhile before the go-ahead is given for aspirin protocol. My guess is that by the time it is, you will be ready to retire.

It should be easy enough for your doctor to figure out what was in the warfarin that caused the allergic reaction. Just have him compare it to the list of ingredients in Coumadin. How did they narrow it down to a warfarin allergy? As Randy said, allergies to warfarin but not Coumadin are rare.

Many people think you got the "gold standard" of valve by getting a St. Jude. Mine has been clicking away nicely for over 14 years.

 

[cpt228]

reaction to warifin

reaction to warifin

Dr felt it could be preservative or dye used
coumadin ctr said that the they had seen reaction to the 5mg more then others they felt it was the dye
i stayed with same dose as the warifin
i was thinking of asking Dr to try diff dose of warifin/big diff in $$$$

any feeling that they will eventually try reduced ac or aspirin therapy with the st jude

 

[Karlynn]

Dr felt it could be preservative or dye used
coumadin ctr said that the they had seen reaction to the 5mg more then others they felt it was the dye
i stayed with same dose as the warifin
i was thinking of asking Dr to try diff dose of warifin/big diff in $$$$

any feeling that they will eventually try reduced ac or aspirin therapy with the st jude

I was thinking dye, or the like.

I have not heard anything in regards to aspirin studies with any valve other than St. Jude. But then, I'm not particularly on the lookout since I've already had my replacement.

 

[jeffp]

Dr felt it could be preservative or dye used
coumadin ctr said that the they had seen reaction to the 5mg more then others they felt it was the dye
i stayed with same dose as the warifin
i was thinking of asking Dr to try diff dose of warifin/big diff in $$$$

any feeling that they will eventually try reduced ac or aspirin therapy with the st jude

If you're on 5mg, the 10mg of both warfarin and coumadin does not have any dye and splits in half easily.

 

[afraidofsurgery]

ATS valve

ATS valve

I have an ATS valve, which is a slightly modified St. Jude design and the valve is quieter. Designed by the same guy who designed the St. Jude, so in my mind they're equivalent.

St. Jude has 25 years of data, and given that sometimes problems with drugs or devices don't show up for quite a while, I'd go with the St. Jude even if I had the choice. The ON-X valve looks excellent in design, though, and I agree the aspirin only trial is promising. Only the endpont results count, though, interim results can sometimes be misleading

Patty

 

[MikeB]

This is the first I have ever heard of this Valve, I myself have a St Jude, and although it is rather loud you get used to it after a few days, the problem I hate is that I have to take coumadin, and I am really bad on going on time for my Protyme.

I would say if it is in the trial stage I would not do it, as I would want to be sure that I am going to be safe and not have to worry about getting another surgery if something doesnt work right with it.

Mike

 

[Dustin]

I have an ATS valve, which is a slightly modified St. Jude design and the valve is quieter.

Do you hear the ATS valve? I've read that it is virtually inaudible.

 

[Enetric]

I am a 37 year old man faced with making that difficult decision of mech Vs. Tissue for an AVR I will be having in the next few weeks. I still havent decided and I have been trying to get as much info in both directions as I can.

I read this article on the site about a week ago and mentioned the On-X valve to the surgeon I will be going to.

He had something interesting to say about this.

He was aware of the trial. he knew all about the valve. He felt there were some interesting aspect to this valve. Felt it was a well made product.

However, he also said that there was no real reason other than marketing to make this valve more likely to suceed with lower anticoagulant use than the St' Judes.

That if the trial itself yeilds favorable results no reason a St. Judes valve couldnt follow in this direction based on a comparions of design, materials and specs. However, he also made it clear to me that he wouldnt want any patient of his participating in the trial itself. That the fear of stoke is still there and a real risk. The trail doesnt take that concern away.

Additionaly he didnt like this valve for me for a specific reason. He says that currently the On-X valve only comes in one size, 25. I am 6-2", a big man and he expects to use a bigger valve on me.

I dont know if anyone else is aware that it only comes in one size, but I thought the info might be helpful if this accurate.

I am new to this compared to many others around here so forgive me if this is wrong...but my understanding the bigger the valve the better the flow? It would seem a good reason for some NOT to want this valve.

 

[Randy & Robyn]

I am a 37 year old man faced with making that difficult decision of mech Vs. Tissue for an AVR I will be having in the next few weeks. I still havent decided and I have been trying to get as much info in both directions as I can.

I read this article on the site about a week ago and mentioned the On-X valve to the surgeon I will be going to.

He had something interesting to say about this.

He was aware of the trial. he knew all about the valve. He felt there were some interesting aspect to this valve. Felt it was a well made product.

However, he also said that there was no real reason other than marketing to make this valve more likely to suceed with lower anticoagulant use than the St' Judes.

That if the trial itself yeilds favorable results no reason a St. Judes valve couldnt follow in this direction based on a comparions of design, materials and specs. However, he also made it clear to me that he wouldnt want any patient of his participating in the trial itself. That the fear of stoke is still there and a real risk. The trail doesnt take that concern away.

Additionaly he didnt like this valve for me for a specific reason. He says that currently the On-X valve only comes in one size, 25. I am 6-2", a big man and he expects to use a bigger valve on me.

I dont know if anyone else is aware that it only comes in one size, but I thought the info might be helpful if this accurate.

I am new to this compared to many others around here so forgive me if this is wrong...but my understanding the bigger the valve the better the flow? It would seem a good reason for some NOT to want this valve.

Your surgeon has not done his homework. The On-X valve is designed for optimum flow with the 25mm valve. the 27/29 size uses the 25mm but with a larger cuff. The On-X has a two-size advantage over other valves due to the larger orifice and better hemodynamics so the 25mm works just fine for larger people.

The only thing the On-X and St. Jude have in common is that they are both bileaflet mechanical valves. There are differences in the materials they are constructed from, the length of the valve, the functionality of the pivot mechanism, the flared inlet and the method of washing stagnant blood from the pivot mechanism.

Do these changes in design make the On-X better than the St. Jude? Not necessarily. But they certainly might. That is what the FDA-approved trial will determine. If you study the morbid event rates for the various valves you will see that the On-X appears to have the edge. Whether this is just a statistical anomaly remains to be seen. The St. Jude has been tested with reduced anticoagulation in the past and did not fair well. Only time will tell if the On-X will prove superior but the potential is there.

Randy

 

[Enetric]

I am sorry I failed to mention that he did tell me that it uses a larger cuff. He was well aware of this.

However, perhaps I do not understand something you are saying. If its still a 25mm, how is that a larger orrifice than a valve that is already a 29mm? Doesnt that mean it has a smaller orrifice but a larger cuff? I think that was his concern about it. That it fails to allow a larger patient to have the best hemodynamics possible. But perhaps this is still my misunderstanding.

I look forward to hearing more of what you have to say about it.

As for the features of this valve, he did say that he felt it had several intersting design ideas as you just mentioned.

However, he felt that for the most part the reasoning behind the "advantage for less anticoagulants" he felt this was going to turn out to be more of a marketing gimick than anything else.

That this was a case of trying to sell the valve as the "no anticoagualnt valve" rather than its materials really making a major difference.

His point was, it would be great if it turns out to be true...but after he really looked it over and studied it (he seemed to know every fact about the valve, te trial, the docs involved, the parent comany, etc) his thoughts were, " I wouldnt want any of my patients to be in a trial like this".

As for the other advantages, he said good things about it. He just thought it was a terrible risk to take with regard to the anticoagulants, and in the long run this may turn out to be more of a marketing gimmick than the "perfect valve" solution we are all hoping for.

Please, correct anything you disagree with. But I thought it was a conversation worth mentioning.

 

[Randy & Robyn]

I am sorry I failed to mention that he did tell me that it uses a larger cuff. He was well aware of this.

However, perhaps I do not understand something you are saying. If its still a 25mm, how is that a larger orrifice than a valve that is already a 29mm? Doesnt that mean it has a smaller orrifice but a larger cuff? I think that was his concern about it. That it fails to allow a larger patient to have the best hemodynamics possible. But perhaps this is still my misunderstanding.

I look forward to hearing more of what you have to say about it.

As for the features of this valve, he did say that he felt it had several intersting design ideas as you just mentioned.

However, he felt that for the most part the reasoning behind the "advantage for less anticoagulants" he felt this was going to turn out to be more of a marketing gimick than anything else.

That this was a case of trying to sell the valve as the "no anticoagualnt valve" rather than its materials really making a major difference.

His point was, it would be great if it turns out to be true...but after he really looked it over and studied it (he seemed to know every fact about the valve, te trial, the docs involved, the parent comany, etc) his thoughts were, " I wouldnt want any of my patients to be in a trial like this".

As for the other advantages, he said good things about it. He just thought it was a terrible risk to take with regard to the anticoagulants, and in the long run this may turn out to be more of a marketing gimmick than the "perfect valve" solution we are all hoping for.

Please, correct anything you disagree with. But I thought it was a conversation worth mentioning.

You are simply failing to take into account the difference between inside diameter and outside diameter. The On-X is constructed of pure carbon versus a carbon alloy. Pure carbon has the structural integrity to allow for much thinner walls, thus a larger effective orifice area and greater flow.

As for marketing gimmicks, I doubt there is a single manufacturer of prosthetic valves, mechancal or biological who is not guilty of such tactics.

I concur with you about the inherent risk in any trial such as this. I would not have the courage to put my life on the line. But my hat is off to those who are willing to take these risks. Only through their efforts and possible sacrifice will we discover the true potential of this valve.

Randy

 

[Enetric]

I couldnt agree with you more. Anyone who has the courage, hats off.

As for the valve...Iwas trying to share a conversation with a surgeon regarded as being a bit of valve guru. For the most part doctors I have spoken with seem to defer to him as "the guy" on valves themselves.

That doenst mean he is the only person in the world to talk to of course. I just wanted ot share what he told me when I excitedly asked him about this valve.

He liked all the features you have mentioned. And he liked the valve. However, he didnt support with the same enthusiasm you see to have for the valve size issue. That isnt to say he is right....but my goal was to share an opinion of a surgeon who has examined it and seemingly done his reasearch.

He seemed to feel strongly that the 25mm size only was more of a concern than the manufacturer or you seem to feel it is.

Hey...I am only the messenger. I brought it up to him and several other well repsected surgeons and cardiologists and he had the most to say. He rattled off dates and names, and trial info, specs...off the top of his head. All I said was,

"Hey, what do you think if the On-X valve and do you think I am good candidate for it?"

Everything I have told you since was what he had to say after he said, "well made product, a lot of interesting features."

He also said, "it would be great if they can do what they are promising."

 

[Mary]

I am a 37 year old man faced with making that difficult decision of mech Vs. Tissue for an AVR I will be having in the next few weeks. I still havent decided and I have been trying to get as much info in both directions as I can.

I read this article on the site about a week ago and mentioned the On-X valve to the surgeon I will be going to.

He had something interesting to say about this.

He was aware of the trial. he knew all about the valve. He felt there were some interesting aspect to this valve. Felt it was a well made product.

However, he also said that there was no real reason other than marketing to make this valve more likely to suceed with lower anticoagulant use than the St' Judes.

That if the trial itself yeilds favorable results no reason a St. Judes valve couldnt follow in this direction based on a comparions of design, materials and specs. However, he also made it clear to me that he wouldnt want any patient of his participating in the trial itself. That the fear of stoke is still there and a real risk. The trail doesnt take that concern away.

Additionaly he didnt like this valve for me for a specific reason. He says that currently the On-X valve only comes in one size, 25. I am 6-2", a big man and he expects to use a bigger valve on me.

I dont know if anyone else is aware that it only comes in one size, but I thought the info might be helpful if this accurate.

I am new to this compared to many others around here so forgive me if this is wrong...but my understanding the bigger the valve the better the flow? It would seem a good reason for some NOT to want this valve.

Thanks for sharing a different perspective.

 

[Randy & Robyn]

There are also detrimental effects from increasing orifice area too much. Mechanical stress increases, regurgitant flow increases and valve noise increases. It seems to be a trade-off with any of the prosthetic valves.

Your opinions and the opinions of your surgeon and welcomed here. Everyone has a different perspective.

I go to Cleveland next week and am hoping to get the On-X. I have done an exhausting amount of research on it. I also have solicited opinions from several highly regarded surgeons concerning it.

This will be my second surgery. My first was a valve repair attempt last fall that failed miserably. I am certainly not looking forward to coumadin but I consider it the lesser evil when compared to the risks of a third surgery.

No one knows what their outcome will be like when undergoing valve surgery. Risk of severe complications is relatively small but they do happen.

Any healthy person walking around today has a 99.99% chance of being around tomorrow. But I can guarantee you that some won't be. Whether it be a tumble down a flight of stairs or a chance encounter with a bus while crossing the street. Life itself carries an inherent risk every day we live it.

All you can do is learn everything you can about your condition and your options. Then make the decision that you feel you can live with best. Good luck.

Randy

I couldnt agree with you more. Anyone who has the courage, hats off.

As for the valve...Iwas trying to share a conversation with a surgeon regarded as being a bit of valve guru. For the most part doctors I have spoken with seem to defer to him as "the guy" on valves themselves.

That doenst mean he is the only person in the world to talk to of course. I just wanted ot share what he told me when I excitedly asked him about this valve.

He liked all the features you have mentioned. And he liked the valve. However, he didnt support with the same enthusiasm you see to have for the valve size issue. That isnt to say he is right....but my goal was to share an opinion of a surgeon who has examined it and seemingly done his reasearch.

He seemed to feel strongly that the 25mm size only was more of a concern than the manufacturer or you seem to feel it is.

Hey...I am only the messenger. I brought it up to him and several other well repsected surgeons and cardiologists and he had the most to say. He rattled off dates and names, and trial info, specs...off the top of his head. All I said was,

"Hey, what do you think if the On-X valve and do you think I am good candidate for it?"

Everything I have told you since was what he had to say after he said, "well made product, a lot of interesting features."

He also said, "it would be great if they can do what they are promising."

 

[Enetric]

Randy,

All the best of luck to you.


You know, I have been posting on forums of interest in my life for years. However, coming from apersepctive as serious as this is new to me.

As I am sure it is to the majority of people whop are reading here on a daily basis. The regualr posters however are the veterans.

I am starting to better understand why something a person might ask, or share that they heard could be a sensitive topic.

My thought initially was, hey if I heard something sharing it could help someone. Not to state is a fact but to exchange info.

For some that will be a good thing. For others, I realize hearing something contrary to the difficult decsions they are making or have made is down right stressfull.

I just want you to know personally, that I only shared the opinions of a the surgeon with regard to other schools of thought. He wasnt by any means knocking the valve.

As for my opinion, I dont have one. That's why I am here. To lerarn from people like yourself and here the debtes. To hear to positives both ways.

In truth, if I go mech. I really WANT to hear the best thing about On-X or any other valve options.

I have a lot less knowledge that you have on it. From what I have read it sounds outstanding.

For all of us ut there facing these choices, I certainly hope they are on the right track, and I wish you all the best of luck and success.

Any other info you can share to educate is great. Believe me when I say reading your feedback has been educational on the topic.

Thanks again and best of luck.

 

[perkicar]

That's very interesting news about CC, Randy.

No wonder they go with the Edwards products. I had originally thought it was because some of the doctors have had product development relationships with Edwards.

The reason may be much more mundane. The Medtronics Mosaic is the most expensive tissue valve on the market, a pièce de cochon on a Rolls Royce budget.

I wasn't aware that they actually limited the selections. I am not a fan of efficiency over choice. There's certainly enough valve business at CC for everyone.

Best wishes,

Dr Lytle went with the carbomedics for me because of my small aortic root and the wider opening of the top hat. I got the impression he thought that was my best option, although I probably wasn't as well versed in the possible choices as some.
I guess it is loud-but I really don't notice anymore. The coumadin is not an issue day to day, although it is stressful when I think about having any kind of surgery. Hopefully that is not in my future anytime soon!