St Jude or On-X or something else

[Swede]

Hi all,

I now have time for surgery, Jan 30th.
And the difficult choice now is to decide which mechanical valve.
I spoke to my surgeon today. The hospital is using St Jude as default but is very flexible and I can choose myself. I told him that I have read a lot of positive about the On-X and he says that would be fine and it is a good valve. On-X is not the normal choice at the hospital though - they have done On-X more on a test basis but he is an excellent surgeon with a very good reputation and do not see any problem to put in an On-X.
I would really appreciate some thoughts on the topic - I like the On-X beacuse of the flow capacity - my Mosaic Porcine has felt a little limiting - my cardiologist has thought the pressure over the valve has been a little on the high side from the start - I am excersising quite a lot and have been in good shape since my first surgery which has made the heart strong but the valve lagging.
So any thoughts/views/experience is most welcome.
Swede

 

[Karlynn]

My St. Jude is 16 years old and working well. If someone insisted on putting in another St. Jude if mine were to need to be replaced I would not be unhappy. However, I would lean to the On-X for the exact reason you are - flow dynamics. Coumadin is not an issue for me - so the promise of possibly no Coumadin with the On-X isn't that important. The fact that I have a Mitral valve replacement which is considered "high risk" for clot formation is what really attracts me to the On-X.

 

[Cooker]

I was able to choose between mechanical and tissue and chose mechanical to try and avoid a second surgery. I never discussed which type of mechanical to go with. I think that would have been too much for me to deal with at the time. My surgeon?s choice was the St Jude. If I do need a reop I will be much more involved in the valve type. Don?t get me wrong, I am pleased with my valve and my overall health but I am a bit more knowledgeable now and able to weigh pros and cons.

 

[Freddie]

I have a carbomedic mechanical valve. Not knowing at the time that I HAD choices for a valve, I went with what my surgeon recommended. Repair if it could be repaired, go mechanical not tissue because of my age - he felt that I wouldn't want to go thorough OHS again.

 

[geebee]

Swede,

I just am not sure how to answer. I am very happy with my St. Jude (in almost 14 years). If I were new to mechanical, I might choose the On-X and I might still should I ever need another surgery. However, I am not a gambler by any chance and tend to lean towards the REALLY tried and true. I know the On-X has been around for awhile now and holds some strong promise for lower ACT ranges but I am still a strong advocate for the St. Jude.

I think I am leery of the "new kids on the block" due to my experience with my old Bjork-Shiley valve (the one that held so much promise and then was recalled). I am NOT saying that would ever be the case with the On-X.

 

[alex c.]

I had to fight for my On-X valves. My surgeon always did St. Jude (which is a great valve also), but I insisted on On-X and was his 1st On-X implant.

 

[Soilman]

I had an On-X installed this past Aug. I did a lot of research to help me decide. What it came down to is mutiple things. On-X has been used for over 10 years without any problems. The flow dianamics are better than any other currently available mechanical valve, the incendent of stroke is lower than any other current mechanical, the coumadin level/INR recommendeded is between 2.0 and 2.5 for the aortic position and research/trials are being conducted (and look promising) that the INR levels can be lowered even further. It's even speculated that coumadin might not be necessary at all.

My surgeon stated quite frankly that I had choosen a "very good valve". He had lots of experience with them and even recommended the On-X before I told him that was my choice. My cardiologist had not heard of the On-X but seemed impress with it and asked me what led me to choose it.

Good luck

 

[Philip B]

Valce Choices

Valce Choices

I had AVR last March. I did the research and really liked the fact that the On-X damages red blood cells less than the St. Jude. My surgeon recommended the St. Jude over the On-X because the On-x was not available with a factory-installed conduit and I needed an aortic graft to address a rather large aortic anneurysm.

The conduit issue was really the deciding factor for me as I wanted to get off the heart-lung machine as quickly as possible. Installation of an On-X would have required additional stitch time to connect the valve to the graft. I opted for the St. Jude. Others have had an On-X installed and the additional graft work done with no complications.

In my opinion both valves are good choices.

-Philip

 

[Guest]

On-X has been used for over 10 years without any problems. The flow dianamics are better than any other currently available mechanical valve, the incendent of stroke is lower than any other current mechanical, the coumadin level/INR recommendeded is between 2.0 and 2.5 for the aortic position and research/trials are being conducted (and look promising) that the INR levels can be lowered even further. It's even speculated that coumadin might not be necessary at all.

My sentiments exactly for choosing OnX for me. I can hear my valve when lying on my back in bed at night and if the room is quiet but otherwise I don't hear it. Sometimes I listen to it just to make sure it sounds right.

My surgeon stretched my aortic root to fit the valve but did not have to do any work on my aorta. I was fortunate in that regard.

 

[andrewg]

I got an on-x aortic valve replacement this past June 2007, in Portland, Maine. I'm 60 years old and had a bicuspid aortic valve.

I opted to be a member of the FDA trials presently being done on the valve, with three groups, one at normal coumadin levels, one at at a reduced level, and one on baby aspirin and Plavix.

After surgery, I was on the normal coumadin therapy, but at three months, was selected to be in the aspirin Plavix group.

It's worked out very well for myself. No more constant INR tests and level adjustments, and I generally feel better being off coumadin.

Now here at 7 months after surgery, I feel great, my stamina is good. I feel very fortunate, and am happy with the on-x valve.

 

[geebee]

I got an on-x aortic valve replacement this past June 2007, in Portland, Maine. I'm 60 years old and had a bicuspid aortic valve.

I opted to be a member of the FDA trials presently being done on the valve, with three groups, one at normal coumadin levels, one at at a reduced level, and one on baby aspirin and Plavix.

After surgery, I was on the normal coumadin therapy, but at three months, was selected to be in the aspirin Plavix group.

It's worked out very well for myself. No more constant INR tests and level adjustments, and I generally feel better being off coumadin.

Now here at 7 months after surgery, I feel great, my stamina is good. I feel very fortunate, and am happy with the on-x valve.

Andrew,

Just curious - are they doing any regular echos looking for clots on the valve or any other tests to determine just how the regimen is working?

Thanks for being a pioneer - you have more courage than I would.

 

[Karlynn]

Andrew - God bless you! I know I wouldn't have the courage to be a part of that study. I too am curious as to how they follow you.

 

[ALCapshaw2]

Hi all,

I now have time for surgery, Jan 30th.
And the difficult choice now is to decide which mechanical valve.
I spoke to my surgeon today. The hospital is using St Jude as default but is very flexible and I can choose myself. I told him that I have read a lot of positive about the On-X and he says that would be fine and it is a good valve. On-X is not the normal choice at the hospital though - they have done On-X more on a test basis but he is an excellent surgeon with a very good reputation and do not see any problem to put in an On-X.
I would really appreciate some thoughts on the topic - I like the On-X beacuse of the flow capacity - my Mosaic Porcine has felt a little limiting - my cardiologist has thought the pressure over the valve has been a little on the high side from the start - I am excersising quite a lot and have been in good shape since my first surgery which has made the heart strong but the valve lagging.
So any thoughts/views/experience is most welcome.
Swede

The Education and Promotion Manager for On-X is Catheran Burnett, RN, who was a Surgical Nurse at Baylor (Dr. DeBakey, et.al.) before going to work in the Valve Industry (St. Jude, Carbomedics, On-X). Her contact information is [email protected] or [email protected]

She can give you the contact information for their Swedish Representative.

'AL Capshaw'

 

[andrewg]

I get an echo every six months, and blood work, etc.

When I was placed in the Plavix group, the study administrator at Maine Medical told me that I was only the second of twenty-two valve recipients to be placed in that group.

You are chosen randomly by a computer, but each group has minimum health requirements, with Plavix evidently being the toughest.

I've been on the South Beach Diet for about four years now, and read Agaston's book on heart disease, which has really helped me to control my weight, blood sugar, and cholesterol levels.

 

[Swede]

First a very big THANK YOU to everyone!

Andrew - thanks a lot for info and also for being part of the study.
Al Capshaw - many thanks for advice and the effort of getting contact details - I will call today.
Thanks Louise, Rachel, Soilman, Philip, Alex, Geebee, Freddie, Cooker and Karlynn.

The support and help from all of you is absolutely fantastic.

To give you an update - I have now spoken to my cardiologist - he thinks I should go for the StJude since that is what the hospital knows and also for StJude being a very safe bet. He has no experience of On-X though. He also says that the flow dynamics is a very small difference once the valve is in place.
Also found another surgeon and he thought StJude is very good and safe and also agreed that the flow dynamics on a work bench is not the same as in the heart - the research he had done showed that valves with "worse" values for flow dynamics performed as well as the "better" ones once in place. He did see big value on not having to be on coumadin if that would be possible - he was not sure about no Coumadin since it still was a mechanical valve. He had no experience of On-X either.
I have another surgeon lined up for today and will keep all of you posted.

In regards to my decision - most of you know how it is - It is so frustrating not having the obvious choice - pros and cons fly all over the place and there is no clear answer.
Take care

 

[ALCapshaw2]

Here's another testimonial from December 2007

From www.ValveReplacement.com - Heart Talk Forum - 2007.12.28

"Update on meeting with surgeon" Thread - Reply #44

First Time On-Xer

I am a "First Time On-X" patient for my surgeon, cardiolgist, and hospital! Thanks to the information I gleaned from this site, I asked my surgeon about the On-X valve during my initial consultation. He said he hadn't used one but would consider it. He contacted the On-X people (who were very supportive), had some On-X valves sent to him, and promptly called me to tell me that the On-X valve was a remarkable piece of equipment.

My aortic valve was replaced on 9/5/07 with a 21 mm On-X valve and it is working wonderfully. At 3 months post-surgery, I had a baseline echo to see how things were doing and the comments from the echo tech, cardiologist, and surgeon were...."this is the best looking valve I've seen - no turbulence, no leakage, perfect!" (emphasis added)

For now, I'm taking Coumadin - it really is not an issue. Don't be afraid of it. However, I do look forward to the day when the studies show (and I believe they will) that less anti-coagulation is necessary with the On-X valve.

Lisa, and all others in the waiting room, a day will come when you just "know" what decision is right for you. Trust your gut and don't look back. Life on the "other side of the mountain" is wonderful !!

(Faye from Willard, Utah)
================

The comment about NO Turbulence is especially relevant because as AL Lodwick has noted, it appears that Turbulence is the major contributor to Clot Formation in mechanical valves.

Turbulence is a 'given' with the Second Generation Valves which do NOT open to a full 90 degrees (most between 70 and 85 degrees if I remember correctly...I'm trying to find that reference), and thus cause turbulence and eddy currents where blood can 'stagnate' and create clots.

The On-X Valve opens to a full 90 degrees. The designer cleverly put a small 'ramp' at the edge which gives it just enough capture of backflow at the end of the pumping cycle to cause the leaflets to turn into the backflow and close. To my (Engineering) mind, this is the Main Advantage of this valve and is the reason that lower anti-coagulation may be viable.

'AL Capshaw'

 

[Karlynn]

Many of us have St Jude valves. It is a great valve and you'll do fine.

 

[geebee]

Sometimes it is best to go with the flow - no pun intended (well, maybe a small one). I would much rather have a valve that was very familar to the surgeon than take the chance with one they seem hesitant to try. Sometimes forcing someone's hand can create issues.

I think you will be very happy with the St. Jude valve but you need to follow your heart (another pun) and your instincts whatever they turn out to be.

Best wishes to you.

 

[Phyllis]

Swede, wishing you the best for your decision and your surgery. Let us know if the date changes and I will put you on the calendar when it is ascertained.

First a very big THANK YOU to everyone!

Andrew - thanks a lot for info and also for being part of the study.
Al Capshaw - many thanks for advice and the effort of getting contact details - I will call today.
Thanks Louise, Rachel, Soilman, Philip, Alex, Geebee, Freddie, Cooker and Karlynn.

The support and help from all of you is absolutely fantastic.

To give you an update - I have now spoken to my cardiologist - he thinks I should go for the StJude since that is what the hospital knows and also for StJude being a very safe bet. He has no experience of On-X though. He also says that the flow dynamics is a very small difference once the valve is in place.
Also found another surgeon and he thought StJude is very good and safe and also agreed that the flow dynamics on a work bench is not the same as in the heart - the research he had done showed that valves with "worse" values for flow dynamics performed as well as the "better" ones once in place. He did see big value on not having to be on coumadin if that would be possible - he was not sure about no Coumadin since it still was a mechanical valve. He had no experience of On-X either.
I have another surgeon lined up for today and will keep all of you posted.

In regards to my decision - most of you know how it is - It is so frustrating not having the obvious choice - pros and cons fly all over the place and there is no clear answer.
Take care

 

[Magic8Ball]

I was the same as Phil above, i went with the St Jude as it came with a factory connected conduit for the anurysm, i didn't want to make the surgery any longer or more difficult by getting the surgeon to stitch the conduit to a valve at the same time.

Had the on-x been available with the conduit pre-attached then i think i may have gone that way instead.

If you don't need conduit then i guess your choice is a little simpler although not any easier...