what to do (St.Jude vs. On-x)

[Hot Rod Harry]

I ended up getting a Mitral Valve "Repair", but went in thinking that I was going to get a mechanical.
In talking with the surgeon, Dr Petterson, at the Cleveland Clinic, we discussed both the SJ valve, and the OnX. He explained the latest advances in the OnX, and the better design, and that it has been proven.. It was recommended, that if I needed a mechanical, Dr Petterson would go with the OnX, without worry.
I ended up getting out of it with a repair, but my research showed that the OnX was the best choice.. Because of the better design, less Cumadin is needed with the OnX, though this is still in study.. I can look through my info and give you specific numbers, if you would like. Or, you can call OnX, and get that info from them. If you are getting by with less Cumadin, then it is a better design, and the chances for blood clotting is less.

I wouldn't loose any sleep if you had to get a St Jude, as it is proven. Good luck with your decision. I know it's a hard one. I didn't make my decision until the very last minute, and got lucky in not needing a mechanical, for a few more years.

 

[Eva]

I ended up getting a Mitral Valve "Repair",.....

I ended up getting out of it with a repair

Congratulations! and may you enjoy this repair for the rest of your life.

 

[juliek]

I don"t need surgery yet and prefer a tissue valve if I do - however, if I needed a mechanical I assumed Dr. William Ryan, (Plano TX) the surgeon I have seen, would use a St. Jude. A cardiologist at Texas Heart had previously told me - when you need surgery they will just slap a St. Jude in you. Dr. Ryan said he prefers the ON- X over the St Jude and described the reasons set forth by Al Capshaw.

 

[Adam S.]

I am set to have aortic replacement surgery in a couple of weeks. I myself 46 yrs old am down to the "ON-X 30yrs" or the "Edward's, Perimount Magna 18yrs" the more I read about blood thinners for my life style it could complicate things for me in some situations. I was also told by my first surgeon to use only the St. Jude valve, He was adamant about it. So I found a more open minded non surgical cardiologist who would debate the pro's and cons on my level. Now I am on a quest to see where the best place in the US is to have surgery installing the Magna. It seems like Cleveland Clinic in Ohio so far. Scuba, it does seem like the perfect paradigm, making the choice, but it is your life dont be so concerned about the surgeons feelings after surgery his job is done and the valve is yours. Try to focus on post surgery, and view the recovery side.
Best.

 

[Lisa in Katy]

It has nothing to do with his feelings. It has to do with skill.

 

[dl_mooney]

I have a OnX & am very happy with it.Do you want a 30 year old Cadillac Or one that is the latest state of the art? Would think that you would rather have the latest one.Its your body & I think you should have the choise.

 

[R&N Brown]

At the end of the day, it's your body, it's your choice.

Knowing there is another surgeon in the same practice that prefers your first choice of valves, be bold, ask him to arrange the introduction.
We're all big kids here, if it "offends" him, tough! I'm sure he'll get over it.

Also, for us, ask why he dismisses the On-X. I have an On-X, happy as h...l with it, and I am curious as to why any doctor would play it down.

The On-X valve is the only one I know of that poses the eventual opportunity to stop putting poison in my body every day. That one possibility would be worth offending my mother for! Much less a surgeon who does not share your same interest.

If your set on an On-X, find a doc that will install it for you.

Rob

 

[Ginger]

I was not a candidate for a tissue valve. I have the St. Jude mechanical and I am on anti-coagulation & aspirin for life. I have a home testing INR kit. I am used to the testing , watch Vit K intake, bruise easily, pre-med for dental work, but the clicking not so much. I have recently experienced the BIG issue of going off warfarin for simple biopsies. I was in the hospital for 6 days for back to back biopsies. Went off warfarin & aspirin, on heparin before biopsies, back on heparin after biopsies, weaned off heparin and back on warfarin. Blood work every 6 hours in the hospital. Next week a followup biopsy - this time approved as outpatient - stop warfarin at prescribed INR, give myself Lovenox shots at home before & after the biopsy, then back on my warfarin & aspirin. ... After reading Al's threads, if I ever had to go through this again, I would want the newer and improved ON-X.

 

[Duff Man]

Why does the on-x study conclude after NINE years (2015)?? That's a long time in the valve replacement world!

Is there any data on the study available yet?

 

[Lynlw]

I was not a candidate for a tissue valve. I have the St. Jude mechanical and I am on anti-coagulation & aspirin for life. I have a home testing INR kit. I am used to the testing , watch Vit K intake, bruise easily, pre-med for dental work, but the clicking not so much. I have recently experienced the BIG issue of going off warfarin for simple biopsies. I was in the hospital for 6 days for back to back biopsies. Went off warfarin & aspirin, on heparin before biopsies, back on heparin after biopsies, weaned off heparin and back on warfarin. Blood work every 6 hours in the hospital. Next week a followup biopsy - this time approved as outpatient - stop warfarin at prescribed INR, give myself Lovenox shots at home before & after the biopsy, then back on my warfarin & aspirin. ... After reading Al's threads, if I ever had to go through this again, I would want the newer and improved ON-X.

I was wonderring why you weren't a candidate for a tissue valve? I hope your biopsies turned out well.

 

[Ginger]

I was told I was no longer a candidate for a tissue valve because of the anuerysm of the ascending aorta coupled with the AVR. I'm sure the second Thyroid biopsy will go well - certaintly hope they get enough tissue this time for a result! Otherwise it is another 3 month healing time between biopsies. My cardiologist discovered the thyroid nodules during the routine carotid artery echo. I had the first thyroid biopsy 3 months ago and a fine needle biopsy of the right breast the same day. The breast biopsy was negative so that was good news! I start the Lovenox injections tonight - can hardly wait! At least I won't have to go back in the hospital again.

 

[Lynlw]

I was told I was no longer a candidate for a tissue valve because of the anuerysm of the ascending aorta coupled with the AVR. I'm sure the second Thyroid biopsy will go well - certaintly hope they get enough tissue this time for a result! Otherwise it is another 3 month healing time between biopsies. My cardiologist discovered the thyroid nodules during the routine carotid artery echo. I had the first thyroid biopsy 3 months ago and a fine needle biopsy of the right breast the same day. The breast biopsy was negative so that was good news! I start the Lovenox injections tonight - can hardly wait! At least I won't have to go back in the hospital again.

Interesting, I've never heard of that as a reason, for not being a candidate for tissue.

 

[Carolg]

Hi Scuba,
i am going to have heart surgery at Cleveland Clinic too and I wanted to get a mechanical vavle but my cariologist keeps telling me to get a pig vavle. I almost am ready to get a 2nd opinion too, even though he's been my cariologist for 20 years

 

[Carolg]

Please tell me about your On-x. I have aortic stenosis and am having surgery this January. I am 62 and my cariologist keeps telling me to get a pig valve and I think I want an On-x instead. Is the On-x the mechcanical valve that you don't have to take coumadin with?

 

[dtread]

There is not any mechanical valve sold in the USA (or anywhere else, that I am aware of) that does not require some kind of medication to help prevent dangerous blood clots from forming on the mechanical valve. The most widely used drug for this is Coumadin® (aka Warfarin). The On-X mechanical valve is currently in the midst of a Clinical Trial to see if various patient groups with the On-X Valve can be maintained safely on lower doses of blood thinner(Coumadin®) or on antiplatelet drugs (aspirin/Plavix®) only rather than the standard dose of Coumadin® and aspirin presently recommended by ACC/AHA or ACCP professional societies.

So, the answer to your question is yes, the On-X mechanical heart valve is the mechanical heart valve that you don't have to take Coumadin® with, but ONLY if you are accepted into the Clinical Trial, and ONLY if you are selected to be in the test arm that is on aspirin and Plavix®. The Clinical Trial is found at: http://www.clinicaltrials.gov/ct2/show/NCT00291525 Note that to get into the Clinical Trial you have to have your On-X mechanical heart valve implanted at one of the Study Locations, and have periodic follow up visits afterwards.

Recommend you do research on your own. Information on the various heart valves is found here:

U.S. Heart Valve Manufacturers:

ATS – Mechanical & Biological Valves (equine). Headquarters: Minneapolis, MN www.atsmedical.com

CryoLife, Inc. – Allografts. Headquarters: Atlanta, GA www.cryolife.com

Edwards Lifesciences - Biological Valves (porcine and bovine). Headquarters: Irvine, CA www.edwards.com

Medtronics - Mechanical & Biological Valves (porcine). Headquarters: Minneapolis, MN www.medtronic.com

On-X Life Technologies, Inc. - Mechanical Valves. Headquarters: Austin, TX www.onxlti.com

Sorin Group (Carbomedics) - Mechanical and Biological Valves (bovine). Headquarters: Austin, TX www.sorin-hv.com

St. Jude - Mechanical and Biological Valves (porcine and bovine), also Alllografts. Headquarters: Minneapolis, MN www.sjm.com

Note: Biological is simply another name for “Tissue”, and Biological Valves are either Bovine (cow), Porcine (pig), or Equine (horse). There are also valves called “Homografts” or “Allografts” that are from cadavers.
Note: Mechanical heart valves today are all the “Bileaflet” design except for the Medtronic mechanical valve, which is the “Tilting Disc” design. In the past there was also the “Ball and Cage” design, but this design is no longer sold in the U.S.
Note: Some of the above also sell products for valve repair (versus valve replacement)

Outside of U.S. Heart Valve Manufacturers (not approved for use in U.S):

Sorin Biomedica Cardio - Mechanical & Biological Valves. Headquarters: Italy http://www.sorinbiomedica.com/

http://www.youtube.com/watch?v=V55FfDnkQ6o

 

[Lynlw]

Hi Scuba,
i am going to have heart surgery at Cleveland Clinic too and I wanted to get a mechanical vavle but my cariologist keeps telling me to get a pig vavle. I almost am ready to get a 2nd opinion too, even though he's been my cariologist for 20 years

Is your cardiologist at CCF too? I thought they mainly used bovine (cow) tissue valves.

 

[andrewg]

Please tell me about your On-x. I have aortic stenosis and am having surgery this January. I am 62 and my cariologist keeps telling me to get a pig valve and I think I want an On-x instead. Is the On-x the mechcanical valve that you don't have to take coumadin with?

I'm 63, and I was fitted with an On-X AVR in June of 2007, in Portland, Maine (same surgeon as R&N Brown in earlier post).

I am part of the FDA anti-coagulation study, and was selected three months after surgery to be in the Plavix/Aspirin group.

Everything has gone quite well since.

Earlier this summer, I had some oral surgery done on my lower jaw. For the surgery, I stopped taking aspirin three days prior, and resumed the aspirin the day after. Once again, no problems with excessive bleeding, etc.

 

[Ross]

Please tell me about your On-x. I have aortic stenosis and am having surgery this January. I am 62 and my cariologist keeps telling me to get a pig valve and I think I want an On-x instead. Is the On-x the mechcanical valve that you don't have to take coumadin with?

At this point in time, you'd still have to take Coumadin with the On-X. Last I heard, they aren't accepting anymore trial patients for the Plavix/Aspirin program, but if I'm wrong, I'm sure someone will correct me.

My question for you is, is longevity something that runs in the family?

 

[ALCapshaw2]

Please tell me about your On-x. I have aortic stenosis and am having surgery this January. I am 62 and my cariologist keeps telling me to get a pig valve and I think I want an On-x instead. Is the On-x the mechcanical valve that you don't have to take coumadin with?

I'm surprised by your Cardio's recommendation for a Pig Valve. Porcine Valves tend to wear out faster than the Bovine Pericardial Tissue Valve which has a proven track record approaching 90% durability at 20 years when placed in patients over age 60 (or was it 65? - I forgot).

CC is a major supporter of the Bovine Pericardial Tissue Valves. Talk to your SURGEON about Valve Choices.

 

[Bill B]

Please tell me about your On-x. I have aortic stenosis and am having surgery this January. I am 62 and my cardiologist keeps telling me to get a pig valve and I think I want an On-x instead. Is the On-x the mechanical valve that you don't have to take coumadin with?

This may sound harsh, but my experience with my cardiologist has shown me that she is virtually ignorant when it comes to valve choice and other surgical issues, and I suspect this is true with most cardiologists. Yes, she follows a lot of patients pre and post-op, but she is only parenthetically aware of the valve surgery literature, and of course, has no direct experience. My cardiologist also thought a bio valve would be fine and they are lasting longer and longer. Well, that may be true in her experience, but in my age group (I'm approaching 62) my current belief is that there isn't much real support for that notion.

How was the decision made to have surgery in January? I hope this was based on a consult with 1 or 2 expert cardiothoracic surgeons who specialize or have a strong emphasis on valve replacement surgery. He or she would be the person to talk to about valve choice issues. If not, it's funny, but my cardiologist thought there was no need for a surgery consult until almost the last minute and that I could get this done almost anywhere by almost anyone. The fact that this is the safest form of cardiac surgery seems to have lulled cardiologists into thinking they can manage you alone until the day before surgery and that the surgery is rather cut and dried. But there are other considerations, like presence or absence of other sometimes related disease (e.g., coronary artery disease, aortic enlargement) that need to be evaluated and could have a big impact on the surgery. Speak to a surgeon or two about this. Just my personal observation.

Oh, and at this point, I don't think it has been established whether you can use the On-X valve without coumadin. That's the subject of an ongoing trial.