Onyx or St. Jude

[Fernac911]

I met with a surgeon today and he recommended that I get a St. Jude valve for my AVR. Based on the research I have done and the information that I have gathered from this forum, I feel like I should get an Onyx valve. The surgeon did make an excellent point regarding the St. Jude's reputation, but I still feel uneasy about it. Which valve should I get?

Also, I live in Houston, TX. Can anyone recommend a surgeon that uses the Onyx valve. I am wanting to make an appointment with Dr. Gerald M. Lawrie, but I don't know which type of valve he uses.

Thanks!!!

 

[RobThatsMe]

I had a St Judes mechanical aortic valve for 10 yrs., but had to get it replaced due to panus growth around it.
I now have an On-X, - 3 yrs and counting.

I would suggest that you call On-X, and they can tell you which surgeons in your area use On-X valves.

 

[tom in MO]

I asked my surgeon the same question. He said that he uses St. Jude since he knows them and they are good long term perfomers. There is a lot of positive history. He did not use the Ony-X because he saw no reason to, but if I wanted it, he'd get one. I went with his suggestion and have a St. Jude. He's the expert, who am I to pick a valve?

After implantation, I found out that due to the long history of the St. Jude, the INR range is now lower at 2-2.5, which is the least amount of anti-coagulation available for mechanical valve patients.

I was also turned off by Ony-X's cash incentive marketing ploy on this forum.

 

[clay_from_nj]

Like tom in MO, I went with what my surgeon recommended, and am quite happy with it. Some of the toughest decisions are the ones where all the alternatives are good ones. I think deciding is a little easier if you don't even think about which might be the "better" valve and look at other factors, like: which might be better suited to your particular situation, which is the surgeon comfortable with, which has better support in your part of the county/world, etc?

 

[pellicle]

I feel like I should get an Onyx valve

Why's that?

Heard of Medtronic? Plenty of good contenders, what draws you specifically to the On-X?

 

[Heart Of The Sunrise]

I choose the ON-X Valve. I am very happy with the results. It was 9 months ago today that it was implanted. My target for INR is 2.0 to 2.5 set by my cardiologist...originally when released from the hospital it was 2.5 to 3.0.

 

[Fernac911]

I've never heard of Medtronic, but I'll definitely look into it! Do you have any information about it that you can share with me?
The reason why I am wanting an On-X valve is because I have read that it has a retardant that may prevent Pannus Tissue Growth and there are current studies where patients are not on blood thinner, such as coumadin.

Why's that?

Heard of Medtronic? Plenty of good contenders, what draws you specifically to the On-X?

 

[clay_from_nj]

I've never heard of Medtronic, but I'll definitely look into it! Do you have any information about it that you can share with me?

My valve is a Medtronic by virtue of the fact that they bought ATS and now put their name on the OpenPivot valves. They are designed to prevent thrombus in the pivot area and are known for being extremely quiet, which is absolutely true, in my experience.

The reason why I am wanting an On-X valve is because I have read that it has a retardant that may prevent Pannus Tissue Growth

St. Jude tried the retardant thing and it led to a recall. The On-X is supposed to inhibit pannus growth due to its physical design. Pannus is not a common problem. One study found 7 out of 390 cases in which patients required surgery to correct pannus growth between 1973 and 2004. The occurrence was 2.4% with the old tilting disk, and .73% with the newer SJM bileaflet design. It seems that it is really not an issue with modern valves. (http://www.ncbi.nlm.nih.gov/pubmed/16998706)

and there are current studies where patients are not on blood thinner, such as coumadin.

Well, there is a study investigating the safety and efficacy of reduced blood thinner (INR 1.5-2.0 instead of 2.0-3.0), but you'll not get away from warfarin that easily. (Looks like ATS/Medtronic beat them to it a while ago: http://www.ncbi.nlm.nih.gov/pubmed/8875175)

 

[Agian]

Well, there is a study investigating the safety and efficacy of reduced blood thinner (INR 1.5-2.0 instead of 2.0-3.0), but you'll not get away from warfarin that easily. (Looks like ATS/Medtronic beat them to it a while ago: http://www.ncbi.nlm.nih.gov/pubmed/8875175)

How come this lower INR research didn't go anywhere? I notice your valve was placed in a 'super annular' position, was that to reduce pannus risk?

The big three appear to be St Jude, On-X and the ATS. I've been told they're very similar.

 

[AZ Don]

Well only you can decide which valve to get. I can tell you that I had to choose a valve as a back-up in case my could not be spared, and I chose the On-X. I would also suggest that you choose a valve that your surgeon is comfortable with (or choose a surgeon that is experienced with the valve you are comfortable with).

 

[Eva]

If your surgeon has implanted ON-X before, I'd ask him for the basis for his preference! He may have the answer that you need to hear!

If he has not yet implanted one, his choice maybe based on his dis-comfort using a new valve he has not implanted before! I heard that a ON-X representative needs to be there when a surgeon uses ON-X for the first time.

Both valves are great. My surgeon preferred St. Jude and I ended up with two St. Jude's valves.

Hope you reach a decision you're most comfy with.

Good luck.

 

[Agian]

St Jude's is trustworthy with a long history. The surgeon who will be operating on me routinely does St Judes. When I saw him the second time I asked him about the On-X again: 'It's a good little unit.' He told me he was becoming increasingly impressed with it.

 

[clay_from_nj]

How come this lower INR research didn't go anywhere?

My guess is because the medical establishment is very conservative, and there haven't been completed, large-scale studies specifically looking at lower INR. Although, I do understand that some doctors are specifying lower INR for valve patients, some I could swear I've seen on this forum.

I notice your valve was placed in a 'super annular' position, was that to reduce pannus risk?

I didn't even realize that until I looked up the serial number after the surgery. That is usually done so as to be able to use a larger valve than would be possible in the usual position, within the annulus. The annulus is a ring of tissue, basically what is left behind after the old valve has been cut out. You can either set the new valve in that ring, right where the original was, or place it on top.

The big three appear to be St Jude, On-X and the ATS. I've been told they're very similar.

All bileaflet valves, made out of the same stuff in the same basic way. (Most people probably couldn't tell them apart by looking at them.) It seems that they are all very good.

BTW - Does anyone have a CardiaMed rotating valve? It looks like an interesting new twist...

 

[pellicle]

BTW - Does anyone have a CardiaMed rotating valve? It looks like an interesting new twist...

very interesting ... had never heard of this before. Seems Russian in design and manufacture. Reading this gave some very interesting insights.

http://www.cardiamed.com/UserFiles/CardiaMed Valve Features.pdf

I loved this bit:

Anticoagulant therapy
Most patients who were examined did not maintain the INR range recommended in the
international standards. More than 60% of the patients had INR below recommended range. Due to this there were practically no events of the anticoagulant-related bleedings

so, don't take your anti-coagulants and don't have a bleed

 

[clay_from_nj]

Very interesting that the CardiaMed is made from solid pyrolitic carbon, while the "foreign" competitors use soft graphite coated with hard pyrolitic carbon. Also of note, they say that the solid pyrolitic carbon is unavailable to "the other current world manufacturers."

 

[clay_from_nj]

very interesting ... had never heard of this before. Seems Russian in design and manufacture. Reading this gave some very interesting insights.

http://www.cardiamed.com/UserFiles/CardiaMed Valve Features.pdf

I loved this bit:

so, don't take your anti-coagulants and don't have a bleed

The next sentence is quite interesting:

At the same time the incidence of thrombolic complications and thromboses corresponds with an average world level of such complications in the patients who maintain their INR within the recommended ranges with the incidence of anticoagulant-related bleedings equal to 4%-8%.

There ya go, On-X, CardiaMed patients don't need no stinkin anticoagulants!

 

[pellicle]

The next sentence is quite interesting:

At the same time the incidence of thrombolic complications and thromboses corresponds with an average world level of such complications in the patients who maintain their INR within the recommended ranges with the incidence of anticoagulant-related bleedings equal to 4%-8%.

There ya go, On-X, CardiaMed patients don't need no stinkin anticoagulants!

yes, I noticed that too, but wasn't sure what to make of it. They didn't give any 'stroke' related data, but I wasn't sure if that was included in thrombic complications ...

I seem to recall a similar statistic from the On-X african data which was (iirc) what started their interest in trials.

I also recall reading that there were other things that were advantageous in anti-coagulation therapy, such as pannus growth.

Thanks for pointing this valve out ... I mean not that I'm going in for a regrind anytime soon ... but I'm a data collector.

 

[knotguilty]

During my reasearch of mechanical valves, most carbons are porous except the On-X which by design has less pores and has a smoother surface , thus making it less likely to cause blood clots to adhear to. I read in an African study they were implanting them and sending people away on aspirin. I do not know the results from that though and not recomending anyone does that of course. ??

 

[clay_from_nj]

Holy Star Trek! Forcefields??!! http://www.ncbi.nlm.nih.gov/pubmed/21329945

 

[pellicle]

Holy Star Trek! Forcefields??!! http://www.ncbi.nlm.nih.gov/pubmed/21329945

And the date seems interesting. I wonder if I have such a valve?

Ahh, but probably not
http://phx.corporate-ir.net/phoenix.zhtml?c=89111&p=irol-newsArticle&ID=1166094&highlight=

Forcefield is a novel technology intended to modify the surface/platelet interaction and adhesion activity with common biomaterials. Dr. Slaughter's study evaluated Forcefield within the cardiopulmonary bypass system during an arrested heart procedure to determine the effectiveness of the surface modification on the prevention of blood platelet adhesion.

"I am very excited about this promising technology from ATS Medical that customizes the surface of vascular medical implants with the goal of preventing platelet adhesion and disrupting the biological processes that lead to adverse clotting and thrombotic events," said Dr. Slaughter.

Great name for a surgeon ... 2nd only to Dr Doom