Replacement in 2 weeks

[Midlo_dave]

Interesting discussion. My surgeon wants to use the ON-X, but not for the potential lower INR. He is recommending a long-term INR of around 2.0 +. He likes the way the ON-X valve attaches. He believes there is less chance of future calcification around the stiches. Has anyone else heard this reason? It may just be his preference. For me, if he has more experience and prefers the surgery with the ON-X, then that is a pretty good reason.

 

[tom in MO]

I’ve had a whirlwind of an experience. Thought I’d introduce myself. I was very sick a month ago and had crazy high BP with ambulance calls. The ER was no help really, but my doctor was incredible. She heard the murmur, saw the hammer pulse and had me get an echo. I was at a point where I couldn’t get out of bed without feeling like I was going to pass out. I. Her office my BP was 230/120. The echo showed severe regurgitation. Praise God she connected me to a good cardiologist who put me in the icu to figure out next steps and have tests (my cardiologist had wanted me to wait 2 weeks just to see him). Anyways, they got the BP regulated and the regurgitation lowered some to moderate. So no emergency surgery. I have clear arteries no dissection. My symptoms are what is driving me to get it done now. The palpitations, shortness of breath and bicuspid valve. my surgeon and I decided on an ON-X valve. I am a runner. (Needless to say this all explains why every time I ran a half marathon I ended up in a tent or hospital feeling like I was going to pass out). I am 48 with a 5 year old and 2 older boys and a granddaughter so I’m praying I’ll be around for a long time after. It just seemed to make sense to have it done while my heart is healthy rather than wait for it to just get worse bc it would definitely need to be replaced anyways. This is a bit of my story.

I’d love to hear how people prepared for this surgery. What things I might need at home to aid I recovery. I’m nervous about the INR but I’ll take it as it comes. And of course the pain is scary but I’m sure meds will help with that!

What things I might need at home to aid I recovery. A clean sheets, easy access to bed and toilet, a good chair, food, drink and a few streaming subscriptions.

I’m nervous about the INR but I’ll take it as it comes. Don't be nervous, it's easy to get the hang of it.

And of course the pain is scary but I’m sure meds will help with that! Pain is not too bad. I've had worse from other operations. I started weaning myself off the pain medication at about day 14.

 

[preciosa1974]

Just as advice, don't over research the problem, there is only so much human cab actually read and grok in the time you have.

Honestly you can't really go wrong with either of the above mentioned valves.

Your diligent engagement INR management will make the biggest difference.

Best Wishes

So I contacted my surgeon’s office and let them know my concerns. The surgeon is going to call me to discuss but the nurse did say they’d have me at a 1.5 INR on on-x. I think I’m going to with the St Jude as I don’t want to deal with thinking it could be lower at all and that ends up having devastating results!

 

[pellicle]

but the nurse did say they’d have me at a 1.5 INR on on-x.

I love the way nurses with no knowledge and no personal experience and no qualifications stipulate things as they do. I get that it's a hard job,

To be honest, get whatever valve you like but run your INR according to established tested guidelines.

Also, don't fret about occasionally dipping low, for a start we need to do that for management around procedures anyway, so it's nothing to stress about.

An example worth reading
https://www.valvereplacement.org/threads/how-long-can-you-go-without-it.887951/
best wishes

 

[pellicle]

He believes there is less chance of future calcification around the stiches.

that's really interesting, I've never heard of calcification around the stitches?

I'm wondering if you might have possibly got wires crossed and he likes the pannus guard (which has nothing to do with calcification)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023143/

 

[Midlo_dave]

that's really interesting, I've never heard of calcification around the stitches?

I'm wondering if you might have possibly got wires crossed and he likes the pannus guard (which has nothing to do with calcification)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023143/

Yes! I believe you (Pellicle) are correct. His point was that the stitches attaching the artificial valve are less likely to accumulate growth around them with the ON-X than the St Jude.

 

[skier]

I got my new St. Jude aortic valve in June. My surgeon uses both ON-X and St. Jude.

He likes St. Jude better because of how it attaches but suggested the ON-X because of the possibility Eliquis would be approved. It would potentially be nice to have Eliquis as an option down the road. He specifically said he didn't recommend the lower INR range for the ON-X

When he got in there, the St. Jude was a better fit, and he could place a larger valve, so he went with that.

A couple of months later, the Eliquis trial for ON-X was stopped. I'm happy I ended up with a St. Jude.

 

[preciosa1974]

I got my new St. Jude aortic valve in June. My surgeon uses both ON-X and St. Jude.

He likes St. Jude better because of how it attaches but suggested the ON-X because of the possibility Eliquis would be approved. It would potentially be nice to have Eliquis as an option down the road. He specifically said he didn't recommend the lower INR range for the ON-X

When he got in there, the St. Jude was a better fit, and he could place a larger valve, so he went with that.

A couple of months later, the Eliquis trial for ON-X was stopped. I'm happy I ended up with a St. Jude.

Thank you for sharing! The more I think about it, the more I feel like I’m going to ask for that instead.

 

[Chuck C]

the nurse did say they’d have me at a 1.5 INR on on-x.

That sounds foolish. Targeting 1.5? The trial which they claim makes the case for INR of 1.5 to 2.0 had an average INR of about 1.9, which is a lot closer to 2.0 than it is to 1.5. It makes no sense to target 1.5. Even if one believes that the trial establishes safety for the lower range, (I don't), then I would argue that the target should be 1.9, if they are trying to truly be consistent with the data from the trial, but targeting 1.5?

It is very common to get readings +/- 0.3 off target and even 0.5 off target happens sometimes. So, targeting 1.5 could get a person in real danger on the low end. And, even if spot on the 1.5 target, that is a dangerous spot to be. Let's hope that she is not the one who will be assisting with your INR management, regardless which valve you choose.

 

[preciosa1974]

That sounds foolish. Targeting 1.5? The trial which they claim makes the case for INR of 1.5 to 2.0 had an average INR of about 1.9, which is a lot closer to 2.0 than it is to 1.5. It makes no sense to target 1.5. Even if one believes that the trial establishes safety for the lower range, (I don't), then I would argue that the target should be 1.9, if they are trying to truly be consistent with the data from the trial, but targeting 1.5?

It is very common to get readings +/- 0.3 off target and even 0.5 off target happens sometimes. So, targeting 1.5 could get a person in real danger on the low end. Let's hope that she is not the one who will be assisting with your INR management, regardless which valve you choose.

I know. This makes me uncomfortable so I’m going to talk to the surgeon about just doing the St. Jude so I don’t have to worry about debating anything.

 

[Beach77]

After my On-X, my cardiologist, INR Clinic and myself decided on a 2.5 - 3.0 range. My cardiologist suggested 2 - 3 but the clinic kept me at 2, which I didn't like. My cardiologist talked with the clinic and my level was moved to 2.5 - 3. I'm not sure why my surgeon choose the On-X. But I'm really happy about it because I rarely hear the ticking. No one has heard it tick.

 

[Zoltania]

What to have at home to aid in recovery: I found it very useful to have a shower seat at first. Also a bathroom scale, a home blood pressure monitor, and several 7-day pillboxes (I had one for morning, one for evening, and one just for warfarin).

Many people swear by having a recliner, but I didn't feel the need for one, probably because I didn't have a sternotomy.

 

[pellicle]

but I didn't feel the need for one, probably because I didn't have a sternotomy.

FWIW I had a full sternotomy twice (as an adult) and never felt a recliner to even be desirable

 

[preciosa1974]

What to have at home to aid in recovery: I found it very useful to have a shower seat at first. Also a bathroom scale, a home blood pressure monitor, and several 7-day pillboxes (I had one for morning, one for evening, and one just for warfarin).

Many people swear by having a recliner, but I didn't feel the need for one, probably because I didn't have a sternotomy.

Thank you! I actually found someone who is going to lend me a lift chair which I think will be very helpful. I was wondering about a shower seat. Thanks for sharing!

 

[jeffp]

A shower seat comes in handy. Even more so, I found a hand held shower head to be very useful.

 

[Superman]

FWIW I had a full sternotomy twice (as an adult) and never felt a recliner to even be desirable

By contrast, I lived in a recliner for about three weeks or so. I found it much easier to sleep in and get up from than a bed. I could use the big cushy armrests to help me hold my six month old daughter. Kick my feet up if I needed to. God forbid I ever have to do this again, I’m going to get a power rocker recliner.

 

[pellicle]

I’m going to get a power rocker recliner.

that was probably significant things against the idea too ... such wasn't really available to a broke uni student ...