Uk nhs - choosing a mechanical valve

[Explorer]

Hi ,

Does anyone know if we have any options to choose the type of Mechanical Valve (On-X, ATS, St. Jude etc) in NHS in UK ?
I am 30 yrs old and have been advised for an AVR in couple of month's time.
My ground work points me towards On-X Valve (better hemodynamics, low pannus growth & lower anticoagulant requirement).
My surgery is scheduled in London Chest Hospital and I was told by default they do St. Jude when I was initially told about impending AVR.
Now that the reality has sinked in, I am planning to get an appointment with doctor and discuss the mechanical valve in detail.

Any pointers with respect to options in UK NHS will be really useful.


Regards
Explorer

 

[rufus]

Hi Explorer,

I didn't get a choice and don't remember any discussion in relation to having a choice - the only choice I had was between tissue and mechanical (although wasn't offered too much of a choice with this really !!).

I had my op at the heart hospital, Westmorland street. I have since had a biventricular pacemaker implanted and again was given no choice about the 'make'.

I would however request if you have a preference (they can only say no !!) - good luck and keep us updated anyway.

 

[pellicle]

Hi

My ground work points me towards On-X Valve (better hemodynamics, low pannus growth & lower anticoagulant requirement).

while not answering your question directly I would suggest you read this

http://www.bme.sunysb.edu/labs/dbluestein/pdf/dumont_2007_comparison_bileaflet_mhvs_cfd_fsi.pdf

it may have something of use for you.

However, the SJM valve generated higher platelet activation values
during the regurgitant flow phase at all ranges of shear stress
accumulation. As this flow phase was previously implicated in
high levels of platelet activation, it indicates that overall, the ATS
valve may offer a lower thrombogenic potential owing to its different hinge mechanism design

and this from the archives here

 

[neil]

i know some of the guys on here asked about the on x valve in the uk, as far as i can remember thats what they had fitted, so worth asking

 

[sue943]

There was someone in the west country who got an On-x but he had to convince the surgeon to do it.

My valves were done through St George's, ie I had the consultant from there but privately in St Anthony's, I was just asked whether I wanted mechanical or tissue, I was 57 at the time so went tissue. No brands were mentioned and I ended up with ATS, they are very quiet and so far causing no problems. I had them in 2005.

 

[Kim54]

I am 3 months posr-op. My AVR was 3 days after a heart cath. I had researched mechanical or bovine. When they were discussing the surgery with me, I knew I wanted a mechanical. I told them I wanted the newest generation of mechanical valves. I also told them I wanted the quietest valve. They told me about the Sorin and It was what I agreed with. The valve has been great, Very quiet. I don't hear it at all, nor anyone else . I am very happy with the choice. I knew if I could hear it, it would drive me up a wall.

Hopes this helps.

 

[chaconne]

I am 3 months posr-op. My AVR was 3 days after a heart cath. I had researched mechanical or bovine. When they were discussing the surgery with me, I knew I wanted a mechanical. I told them I wanted the newest generation of mechanical valves. I also told them I wanted the quietest valve. They told me about the Sorin and It was what I agreed with. The valve has been great, Very quiet. I don't hear it at all, nor anyone else . I am very happy with the choice. I knew if I could hear it, it would drive me up a wall.

Do you know what size your valve is? I've heard this is one of the factors in how loud a valve is. The bigger, the louder.

 

[Kim54]

Do you know what size your valve is? I've heard this is one of the factors in how loud a valve is. The bigger, the louder.

Chaconne,

My valve is 19mm, almost an inch. I believe it is small or medium. When I was discussing which valve I wanted with my surgeon, they knew I wanted the quietest on the market. So they told me the Sorin R5-019 would be quiet. I repeatedly asked them " are you sure it is quiet " and they told me I would not hear it. This is a 2nd generation valve.

 

[pumpkinhead]

I have a valve thru St. Jude, just got my tracking card yesterday. This thing is LOUD, but according to my surgeon I also have a big heart, so I am sure its a big valve. I feel it thumping in my throat and ticking in my head at all times. I will either get used to it or go to the crazy bin.

 

[valveanddissection]

I have a st jude, 2.5 years now....I dont have a tracking card???? should I? I know its in there I have the scar to prove it and can hear it too...

 

[chaconne]

My valve is 19mm, almost an inch. I believe it is small or medium. When I was discussing which valve I wanted with my surgeon, they knew I wanted the quietest on the market. So they told me the Sorin R5-019 would be quiet. I repeatedly asked them " are you sure it is quiet " and they told me I would not hear it. This is a 2nd generation valve.

19mm is one of the smallest sizes, I think. This would seem to correlate with what I've heard. I have the largest On-X: 29mm, but it's really just the 25mm with extra cuff. Mine is moderately quiet. I only hear it in a quiet room. Others rarely hear it.

 

[virginian777]

what is a tracking card anyway?

 

[pumpkinhead]

I have a st jude, 2.5 years now....I dont have a tracking card???? should I? I know its in there I have the scar to prove it and can hear it too...

what is a tracking card anyway?

Its a Card they send you post surgery....with all your identifying factors on it...i.e. surgeon, serial number, model number, etc.. they tell you to carry it with you at all times, in case their is a problem and they need to do emergency surgery. It comes in a plain white envelope and looks like junk mail, I would assume a number of them get thrown away.

 

[dwhist]

I have a st jude, 2.5 years now....I dont have a tracking card???? should I? I know its in there I have the scar to prove it and can hear it too...

My doctor gave me a hand written card when I left hosptial and about 2 monhts later I got the real card. Below is link that should get you contact info for St Jude so you you can contact ehm. I am sure they will send you a card.

http://www.sjmprofessional.com/~/link.aspx?_id=343278150B1E43F18EAEC75F2DA1DBA7&_z=z

 

[Madsometimes]

I had an ATS valve put in at St George's. I didn't ask the brand before my op, the discussion was more about tissue vrs mechanical. However, I think that most valves are very similar in their efficiency. Personally I think going with a valve that a surgeon feels comfortable about working with is more important than exerting patient choice. Although I am pleased that my surgeon chose ATS, I know that many people live healthy lives with St Jude's valves too. Having said that, if you really do not want a St Jude's valve, then don't have it. It's your body and you must feel comfortable with the valve that is implanted.

 

[pellicle]

Hi

I had an ATS valve put in at St George's. I didn't ask the brand before my op, the discussion was more about tissue vrs mechanical.

Perhaps its because I'm a colonial boy that I tend to agree wth you. I was facing my third op and did not relish a fourth. The surgeon was of the same mind.

As it happened between 'that angiogram' and surgery I had done some reading and found the on-x valve. My surgeon as it happened to prefer the ATS valve. His reasons were based on operational success and the availability of a pre stitched raising aorta which was not available in Australia as readily.

However, I think that most valves are very similar in their efficiency. Personally I think going with a valve that a surgeon feels comfortable about working with is more important than exerting patient choice.

I agree with this in full. I believe when patients know one one hundredth as much about it as the surgeon, and have followed up as many cases, and been associated with as many surgeries then perhaps they will be qualified to venture an opinion.

The journals indicate quite close design parameter triangulation and extraordinary similarity of outcomes. We are not after all discussing washing machines cars or football teams.

Btw in Australia my ATS came with a coaguchek XS as a gift. Something I only found out about post surgery.

 

[SimonB100]

My father had an AVR at the Oxford Radcliffe in the UK, although he opted for tissue. I don't recall what mechanical options were available there, although I could easily find out and revert. If it were me, at your stage of life, I would go ON-X. I understand that trials are awaited on whether the ON-X could be managed with only SuperAspirin moving forward - comparatively this valve seems to fare well.