On-x vs St Jude

[jarno1973]

Looks like soon I will be going in for re-surgery after my tissue valve is giving up after 6 months. My initial choice for tissue over mechanical was fairly easy but I had to jump through a lot of hoops (including changing surgeon) to get it done.

I will almost surely have to get a mechanical valve this time but I may get into a similar situation. I have been reading about the On-x and am getting a good feeling about it mostly because the possibility of reduced warfarin. In my hospital the On-x is however not yet used. Most used are apparently the St Jude, Omni science and Medtronic Hall. Initially I thought that Omni science was a type of St Jude valve but it looks like omniscience is actually a brand on its own which means that is my hospital they will most likely be using the latest model of the St Jude which I believe is the Regent.

I mentioned the On-x to my surgeon and it seems like he would not have a problem to use it but it would be more a matter with the administration in the hospital (to actually get them ordered etc). He also mentioned that all manufacturers of valves are studying the possibility of reducing the need for anticoagulation as this is the biggest issue with mechanical valves. My preference for On-x may be partly be caused by visiting this site which seems to be sponsored by On-x. If the technology and materials of the latest St. Jude and On-x valves are actually the same there may be no specific reason for me to choose On-x over St Jude. I tried searching the internet and a lot of more information about reduced anticoagulation comes up for On-x than for any other brand.

I have searched and found some older topics about this subject but hope that maybe some people have the latest information at hand. I'll ask some questions in the hope that someone has the answers:

Is there any difference in technology/materials between the latest St Jude valve (the Regent apparently came out after the on-x) and the On-x? Even though On-x does more of the research and testing, could it be that if the trials work out well that St Jude can almost basically draw the same conclusions because the technology/materials used are the same?

I have heard of the testing program by On-x which should be finished in 2015. Does anybody know if StJude has or is planning somthing similar? Or does their valve design just not have any features that could possibly reduce the need for anticoagulation?

What is your opinion about having an on-x installed by a surgeon that has never installed this specific valve? Some people on here state that would be something to avoid but gave no real reason. There are quite a few examples of people on here who actually were the first to receive an On-x of their specific surgeon. According to my surgeon there is no real difference in "sewing" in another brand valve. The principles remain exactly the same.

Thanks for any replies in advance.

Regards,

Jarno

 

[Bina]

My surgeon (chief of cardiac thoracic surgery in Montreal) chose the St. Jude Regent in our pre-surgery discussion.
There are many of us here with this newer valve and all are doing very well. I would choose it again if needed.

 

[2003miata]

I can't provide much insight into the differences between the St Jude Regent valve and the On-X valve, but I had an On-X valve installed for the same reasons you are considering. My surgeon had never installed an On-X valve, but agreed to use one. As far as I can tell, I may have been the first at this hospital to get one, since my cardiologist has not had a patient with an On-X valve. My surgeon arranged to have an On-X rep at the surgery for technical advice. After the surgery, the surgeon told me that the installation of the On-X valve was very similar to the St Jude's valve (he did say it had a deeper annulus, but I have no idea what that meant).

 

[RealtorRick]

I just had AVR on 1/11/11. I too had read so much on the issue and the "advertisements" by On-X. My surgeon said has installed some On-X valves but personal preference is St Jude. He gave me the choice but said the sheer numbers of St Judes valves out there makes them tried and proven. I went with him and got a St Judes. I am thinking that mech valve brand choice is probably not all that important, they are all good. Not sure I know anybody that had one recalled!! No matter what your choice, be at peace with the decision. You may second guess yourself many times over, as I already have, but in the end, be glad that you have a choice and that you are on the getting better side of surgery.

 

[jarno1973]

Thanks for the responses.

I don't doubt at all that the St Jude will be a very good valve but anti coagulation is such a big issue for me. If in 3 years the On-x trials are finished and possibly a lot of people with On-x could reduce their anti coagulation and people with St Jude would not have the same outlook, I would probably regret my decision.

 

[dtread]

Jarno, the Medtronic Hall and OmniScience are both Tilting Disc design, which is older technology. The flow is not as good as with Bi-Leaflet design. Might work okay for Mitral position where the flow is less, but rarely used these days in the U.S., especially for Aortic position. Didn't know they were still producing the OmniScience - don't think it is being sold in the U.S. but I may be wrong. This provides a good comparison of the On-X versus St Jude valves, including the St Jude Regent model: http://www.onxlti.com/2011/09/clincal-update-thirty-seven/

FYI, I specifically requested the On-X and got the first ever implanted at Washington Hospital Center and by my Surgeon. On-X sent in a rep that was there during the surgery to answer any questions or whatever that the Surgeon might have had. On-X is the only company with a Clinical Trial ongoing in the U.S. for reduced anti-coagulation. The Clinical Trial is found here: http://www.clinicaltrials.gov/ct2/show/NCT00291525

Good luck with whatever you decide.

 

[normofthenorth]

Jarno, do you understand WHY your first valve is failing at 6 months? I don't think there are any "normal" mechanisms to develop ordinary valve deterioration that fast, no matter how young you are, so if it really needs replacement (unless you've had an outbreak of Bacterial Endocarditis), there may well have been a problem with the surgery. As impressive as the On-X's studies and campaign and lower-INR hopes are, and as popular and well tested as the St. Jude is, I think personally I'd concentrate on getting the most talented, most successful, and most highly rated surgeon to do your next AVR. If you know any nurses, or other doctors, etc., who work in the system or even at that hospital, they probably have info and opinions.

Just a thought, from a different angle.

 

[jarno1973]

Jarno, do you understand WHY your first valve is failing at 6 months? I don't think there are any "normal" mechanisms to develop ordinary valve deterioration that fast, no matter how young you are, so if it really needs replacement (unless you've had an outbreak of Bacterial Endocarditis), there may well have been a problem with the surgery. As impressive as the On-X's studies and campaign and lower-INR hopes are, and as popular and well tested as the St. Jude is, I think personally I'd concentrate on getting the most talented, most successful, and most highly rated surgeon to do your next AVR. If you know any nurses, or other doctors, etc., who work in the system or even at that hospital, they probably have info and opinions.

Just a thought, from a different angle.

Hi "normofthenorth",

Thanks for your reply. I have disussed my surgeon in another topic. It is very difficult to decide what to do with this. I really have a good impression of him and especially chose him over others. I did investigate and he is one of the best in Thailand (this is where maybe some people will question the standard of health care in Thailand). All of these surgeons are trained in the US and my specific Dr. is one of the Doctors involved in treatment of the King of Thailand which should mean something as well. I dont think I will ever find out if any mistakes have been made and so far do not have a real reason to believe there were. I dont want to just run to another doctor but maybe it will be best to get a few more opinions. Regardsless of this all I will have to make a choice in mechanical valve.

 

[normofthenorth]

Thanks, Jarno. It sounds like you're doing what you can (& should) in this challenge. Me, I think I might go with the SJ for surgeon comfort. Esp. if On-X can't send a rep to your OR in Thailand.

 

[jarno1973]

I will try to to get to the bottom of it all, so I can make the best decision. I am contacting St Jude a the moment. I hope they will have some useful replies. I will also contact On-x. I hope that flying a few extra miles will not be an issue for the On-x rep.......

 

[chaconne]

The On-X has a lot of compelling features, but none of them have been proven to make it better than other valves yet, with the possible exception of the barrier to pannus in-growth. I got the this valve because I think it's at least as good as the others and could very well be better in some of the categories it claims to be. The thing that attracted me to the On-X the most was the pure pyrolitic carbon, making it smoother and more flexible than silicon alloyed carbon. It seems to me that this increase in material toughness will ensure that it will outlast others on average.

 

[jarno1973]

The On-X has a lot of compelling features, but none of them have been proven to make it better than other valves yet, with the possible exception of the barrier to pannus in-growth. I got the this valve because I think it's at least as good as the others and could very well be better in some of the categories it claims to be. The thing that attracted me to the On-X the most was the pure pyrolitic carbon, making it smoother and more flexible than silicon alloyed carbon. It seems to me that this increase in material toughness will ensure that it will outlast others on average.

Dear Chaconne,

Thanks for your reply. Very useful information. I think that the pyrolitic carbon is one of the characterics which On-x claims will have less tendency to produce cloths because of the smoothness. Do you know what material the St Jude regent is made of? Is this silicon alloyed carbon? Or similar to what on On-x uses?

Regards,

Jarno

 

[RobThatsMe]

The On-X has a lot of compelling features, but none of them have been proven to make it better than other valves yet, with the possible exception of the barrier to pannus in-growth. I got the this valve because I think it's at least as good as the others and could very well be better in some of the categories it claims to be. The thing that attracted me to the On-X the most was the pure pyrolitic carbon, making it smoother and more flexible than silicon alloyed carbon. It seems to me that this increase in material toughness will ensure that it will outlast others on average.

Hi,

I agree with your thoughts on this.
I had a St Judes mechanical aortic valve for 10 years, then if failed due to pannus development.
The valve, I am sure was fine, but due to the pannus growth, it was not functioniong properly.
I chose the On-X to replace my St. Judes, mostly because it has some features that can deflect panus from interferring with it's function.

It is my understanding that if your body is prone to pannus, that it will try again to block this valve. Hopefully the On-X design will prevent that.

Rob

 

[Lynlw]

Hi,

I agree with your thoughts on this.
I had a St Judes mechanical aortic valve for 10 years, then if failed due to pannus development.
The valve, I am sure was fine, but due to the pannus growth, it was not functioniong properly.
I chose the On-X to replace my St. Judes, mostly because it has some features that can deflect panus from interferring with it's function.

It is my understanding that if your body is prone to pannus, that it will try again to block this valve. Hopefully the On-X design will prevent that.

Rob

Rob, Since Justin is very prone to pannus usually right at the seam gets stenosised, So i've wonderred (but of course never contacted the to ask since he doesnt need surgey hopefully) so maybe you know, from what I understand the on-x valve is designed to keep pannus from encroaching on the leaflets, which is good, but I'm guessing the body still makes the same amount of tissue, so would it back up/grow quicker on the seam, or is there some kind of protection for that?

 

[Jailene777]

I have an On-x valve in the mitral position. I would not advise to have a surgeon that never implanted an on-x valve to implant one on you. I dont know how do you feel about experimentation, but I personally wouldnt recommend being someone's guinea pig. This is your life on the line. Your heart is stopped to perform this replacement, and you need someone that is knowledgeable for the job. I was grateful that my surgeon works fast and has 50 years of experience. I was offered a st.Jude before surgery and woke up with an On-x and Im quite happy with that. I think he made the best decision because I'm young and I need to be on coumadin for the rest of my life.

 

[chaconne]

Thanks for your reply. Very useful information. I think that the pyrolitic carbon is one of the characterics which On-x claims will have less tendency to produce cloths because of the smoothness. Do you know what material the St Jude regent is made of? Is this silicon alloyed carbon? Or similar to what on On-x uses?

It is my understanding that all other carbon mechanical heart valves, other than the On-X, use carbon alloyed with silicon. This makes the carbon more brittle and not as smooth as the pure pyrolitic carbon at the microscopic level. The inventor of the carbon used in all heart valves, Dr. Jack Bokros, is now the president of On-X. In my discussions with him, he believes his latest invention to be a step up from all the others and is confident that it will soon be proven so.

On-X sent me a ring made out of the pure carbon, under a microscope it still looks very smooth, however I was only magnifying it 50x or so. I'm hoping that the On-X proves to have advantages, especially in regards to clot formation.

 

[RobThatsMe]

Rob, Since Justin is very prone to pannus usually right at the seam gets stenosised, So i've wonderred (but of course never contacted the to ask since he doesnt need surgey hopefully) so maybe you know, from what I understand the on-x valve is designed to keep pannus from encroaching on the leaflets, which is good, but I'm guessing the body still makes the same amount of tissue, so would it back up/grow quicker on the seam, or is there some kind of protection for that?

Hi Lynlw,

I don't know the answer to that. Does the body continue to grow and grow pannus? Hmmm... Good question for the doctors.
I'll ask this on my next appointment.

knowledge is power..

Rob

 

[jarno1973]

Rob, Since Justin is very prone to pannus usually right at the seam gets stenosised, So i've wonderred (but of course never contacted the to ask since he doesnt need surgey hopefully) so maybe you know, from what I understand the on-x valve is designed to keep pannus from encroaching on the leaflets, which is good, but I'm guessing the body still makes the same amount of tissue, so would it back up/grow quicker on the seam, or is there some kind of protection for that?

Wow..this thread is really coming to life...I like that...lots of useful information

The above is something else for me to dig into. One of the theories is that my tissue valve is failing after 6 months because of calcification and the leaflets looking thickened. I think calcification is almost out of the question after only 6 months. If pannus also grows on the leaflets this could possibly be the problem with my valve at the moment. I will try to get that investigated, if true I have one more reason to consider On-x over St Jude.

Anybody knows if pannus growth can become a problem very quickly?

Jarno

 

[Lynlw]

Wow..this thread is really coming to life...I like that...lots of useful information

The above is something else for me to dig into. One of the theories is that my tissue valve is failing after 6 months because of calcification and the leaflets looking thickened. I think calcification is almost out of the question after only 6 months. If pannus also grows on the leaflets this could possibly be the problem with my valve at the moment. I will try to get that investigated, if true I have one more reason to consider On-x over St Jude.

Anybody knows if pannus growth can become a problem very quickly?

Jarno

Pannus CAN grow very quickly, BUt from what I know it wouldnt just grow on the leaflets, IF it affects the leaflets, it us usually as far as I know because it forms from where your own tissue is sewn, to a part or even your own tissue so you would most likely see stenosis starting where the valve is sewn.

Calcification can be a little quick, but even in teens/children months would seem like a part was a little small to start with in my unofficial unmedical opinion.

 

[RobThatsMe]

Wow..this thread is really coming to life...I like that...lots of useful information

The above is something else for me to dig into. One of the theories is that my tissue valve is failing after 6 months because of calcification and the leaflets looking thickened. I think calcification is almost out of the question after only 6 months. If pannus also grows on the leaflets this could possibly be the problem with my valve at the moment. I will try to get that investigated, if true I have one more reason to consider On-x over St Jude.

Anybody knows if pannus growth can become a problem very quickly?

Jarno

Hi Jarno,

In my personal case, the effects of the pannus development began to show on my echocardiograms after 8 years. It went downhill from there, and I was told during year 10, that either I get the valve replaced, or that I would not be around in 6 to 12 months.

The pannus was growing out from under the valve leaflets, and not allowing them to fully open or close.
As I have said many times on this forum, "while it is true that valves can outlast our lifetime, there is no gaurantee that other factors can influence their function and cause failure." I am sure that the St Judes that I had would still be working fine, if I did not have the pannus issue.

So, I opted to try the On-X on the re-op. Why not! I only got 10 years from the St Judes, and St. Judes valves still did not have any feature that would help prevent what had occured in my case. On-X did, so I figured lets give this valve a try. Only time will tell.

Rob