Which model should I get?

[Old Hippie]

Gees, ya?ll are talking about picking a valve as if it were an automobile. ?Do I get the 4 wheel drive or the ALL wheel drive?? ?I like the Ford but the Chevy get?s better gas mileage.?

Since I was informed about a month ago that I would be the proud parent of a new mitral valve next month I?ve been trying my best to be an educated consumer. I have Googled the words ?heart valve? till I?m blue in the face.
This is all great for those that have had a ?valve job? before. I?m facing my first next month.

I could spend days deciding, lets say on an On-X. I get to my appointment with the surgeon and he says ?Sorry, I don?t use that brand.? I just can?t get in my car and drive down the street to the next ?dealer?.

 

[temp69]

On-X a winner

On-X a winner

at least for me, an old hippie, too. smoked more pot than geronimo and here i am, 56, a thriving screenwriter.

vis a vis the on-x, i had the experience of going to one of the best in the business, Dr. Laks at UCLA and he championed the On-x and lo and behold, it works! supposed to last 150 years, but i got the extended warranty just in case.

any questions, go ahead and shoot me an email.

t

 

[Ross]

I'd suggest reading Tobagotwos writings at the top of the valve selection page and then decide if you want to go tissue or mechanical, then we can go from there.

 

[ALCapshaw2]

Have you contacted Catheran Burnett at On-X?
([email protected] or 888-339-8000 ext 265)
Catheran is a former Cardiac Surgery Nurse who has worked at Carbomedics (7 yrs), St. Jude (2 yrs), and now works for On-X. She 'Knows her Stuff' when it comes to Heart Valves!

She will be happy to send you a very extensive information package that includes a booklet about ALL types of valves, information sheets on the On-X valves, and a couple of sheets that show comparative data for Morbid Event Rates (Thromboembolism, Thrombosis, and Hemorrhage) for the 5 main suppliers of Mechanical Valves.

I was very impressed with a not-too-distant surgeon but when I interviewed him after my Mitral Valve symptoms worsened, I learned that he had never used On-X valves. His surgical assistant asked me to provide more information so I had On-X set up a meeting. The surgeon was impressed with their valve, said he would have NO problem implanting it, and agreed to use On-X for my Mitral Valve Replacement when the time comes.

Based on the data I have seen from On-X (and some comparison data from other manufacturers that correlates with the On-X data), I believe that the On-X Valve has the Lowest Propensity for Clot Formation in the Mitral Position, so I have chosen On-X as my First Choice, and the STANDARD St. Jude Valve as my Second Choice. It is always a good idea to have a Plan B just in case there is some reason that the Plan A valve is not viable once the surgeon 'gets in there'.

The other Mechanical Valve Manufacturers in the USA are ATS, Carbomedics, Medtronic-Hall, and St. Jude. You can find their websites using Google.

'AL Capshaw'

 

[Cooker]

This would be my personal choice..............oh, you meant valves



View attachment 5082

 

[WayneGM]

I didn't have to go through valve selection as I had a repair, but I'll offer an opinion anyway....if it were me, I'd start with picking the right Surgeon, somebody who you believe in and trust. After that, I'd do the valve research so I could have an informed discussion about the options but ultimately I would look to the Surgeon, as the expert I picked, to steer me right. I wouldn't be comfortable with picking the model through my own research, and then finding a surgeon who would do it. Just my opinion on how I'd approach it. Good luck.

 

[ALCapshaw2]

I didn't have to go through valve selection as I had a repair, but I'll offer an opinion anyway....if it were me, I'd start with picking the right Surgeon, somebody who you believe in and trust. After that, I'd do the valve research so I could have an informed discussion about the options but ultimately I would look to the Surgeon, as the expert I picked, to steer me right. I wouldn't be comfortable with picking the model through my own research, and then finding a surgeon who would do it. Just my opinion on how I'd approach it. Good luck.

I respectfully disagree with this approach (to find the surgeon First, then discuss options). I expect no one is surprised by that revelation.

The BEST example I can think of is for patients who are interested in a ROSS Procedure. I doubt that anyone would seriously consider an otherwise EXCELLENT surgeon who had never (or rarely) done an RP. Remember StretchL's search for the Best-of-the-Best RP Surgeons?

Would anyone consider a REPAIR from an otherwise EXCELLENT surgeon who has NOT performed any (or many) repairs?

I expect that similar arguments could be made for less critical choices, to a lesser extent, admittedly.

My AVR surgeon agreed to implant a Bovine Pericardial Valve but switched to a St. Jude Mechanical after 'getting in there' and seeing the extent of scar tissue damage which makes me wonder how much he understood about Radiation Damaged Hearts before my surgery. Fortunately, he was a good enough surgeon that he was able to deal with the scar tissue successfully.

Since then, I have found another surgeon who knew more off the top of his head about Radiation Damage than anyone I have ever talked with before. (And he is willing to use an On-X valve for my pending MVR).

Bottom Line: You want to find a Good Surgeon who is experienced with YOUR condition and all of the best options for YOU.

'AL Capshaw'

 

[WayneGM]

I respectfully disagree with this approach (to find the surgeon First, then discuss options).....

....My AVR surgeon agreed to implant a Bovine Pericardial Valve but switched to a St. Jude Mechanical after 'getting in there' and seeing the extent of scar tissue damage which makes me wonder how much he understood about Radiation Damaged Hearts before my surgery.......

Bottom Line: You want to find a Good Surgeon who is experienced with YOUR condition and all of the best options for YOU.

Al, when you say your AVR surgeon "agreed" to implant the Bovine Pericardial valve do you mean that was the valve you selected based on your own research and then you sought out a surgeon who would agree to use it? If so, it sounds like the higher priority would have been to find a surgeon with expertise with radiation damaged hearts first. In any event, my point was that I personally wouldn't be comfortable picking the valve (i.e. solution) first and then finding a surgeon that would do it (in response to Old Hippie's analogy in his original post). I'd approach it by finding the Surgeon with the best knowledge and experience with my condition and seek a recommendation based on their expertise (sounds aligned with your "bottom line" comment) recognizing that the "best option" isn't necessarily the one that might have interested me through my own research.

That said I don't disagree with your approach, for those who believe they have sufficient knowledge and understanding of their heart condition to draw a conclusion on the specific option(s) they believe are best for them and want to pursue. Personally, I don't believe I have sufficient knowledge and understanding so I rely heavily on the expert to steer me in the right direction, so my inclination would be to find the expert first. I don't think either approach is wrong or right. I think it's a matter of comfort, confidence, and choice.

 

[ALCapshaw2]

Al, when you say your AVR surgeon "agreed" to implant the Bovine Pericardial valve do you mean that was the valve you selected based on your own research and then you sought out a surgeon who would agree to use it?

AC: YES, I consulted with my PCP and Cardiologist about valve options. My PCP recommended the Bovine Pericardial after doing her own research and my Cardiologist suggested I also ask the surgeon about a Ross Procedure.

If so, it sounds like the higher priority would have been to find a surgeon with expertise with radiation damaged hearts first.

AC: I agree (now), but at the time no one raised that issue as the underlying cause of my heart damage.

In any event, my point was that I personally wouldn't be comfortable picking the valve (i.e. solution) first and then finding a surgeon that would do it (in response to Old Hippie's analogy in his original post).

A.C. For most patients, and especially patients who have NOT conducted their own research and self education, that is probably best. I would add that Multiple Opinions from Surgeons and Cardiologists is a good idea, especially for patients who are not well informed on Heart Valve issues.

I'd approach it by finding the Surgeon with the best knowledge and experience with my condition and seek a recommendation based on their expertise (sounds aligned with your "bottom line" comment) recognizing that the "best option" isn't necessarily the one that might have interested me through my own research.

That said I don't disagree with your approach, for those who believe they have sufficient knowledge and understanding of their heart condition to draw a conclusion on the specific option(s) they believe are best for them and want to pursue. Personally, I don't believe I have sufficient knowledge and understanding so I rely heavily on the expert to steer me in the right direction, so my inclination would be to find the expert first. I don't think either approach is wrong or right. I think it's a matter of comfort, confidence, and choice.

We're probably not that far apart. I see that you used Dr. David who is Well Known as an Outstanding Surgeon.

The problem, especially if consulting only ONE surgeon, is that surgeon may only be comfortable with a limited range of options and not even mention the alternatives that MAY be applicable to a particular patient (such as RP or Repair or the latest and greatest Mechanical or Tissue Valves). This is were it is important for the patient to at least become familiar with the various options.

FWIW, I was referred to a local surgeon (who did my CABG) when first diagnosed with Aortic Stenosis. He limited his offerings to a Bovine Pericardial and St. Jude Mechanical Valve (which was an adequate selection for me as it turned out). When I sought a second opinion, I was referred to the Major Heart Center in my state and decided to go with one of their top surgeons (who specialized in Heart Transplants).

Either way, it is wise to find an Excellent Surgeon with experience in your condition and the best options for your issues.

'AL Capshaw'

 

[Guest]

This would be my personal choice

*grins*

Mine, too..........


So, I'll take one of those ... in one of these:
http://www.chevyasylum.com/cort/DSC07639r8.jpg





Cort:33swm."Mr Monte Carlo.Mr Road Trip".pig valve.pacemaker
WRMNshowcase.lego.HO.model.MCs.RT.CHD = http://www.chevyasylum.com/cort
"Only you can do what must be done" ... John Parr ... 'St Elmo's Fire'

 

[ALCapshaw2]

That said I don't disagree with your approach, for those who believe they have sufficient knowledge and understanding of their heart condition to draw a conclusion on the specific option(s) they believe are best for them and want to pursue.

Personally, I don't believe I have sufficient knowledge and understanding so I rely heavily on the expert to steer me in the right direction, so my inclination would be to find the expert first. I don't think either approach is wrong or right. I think it's a matter of comfort, confidence, and choice.

I understand where you are coming from Wayne and that is certainly a valid approach. When I first learned of my Valve issues, I didn't know squat about heart valves and relied on my Doctors for advice.

In retrospect and 5 years on VR.com I've learned a LOT about different Valve options and the trade-offs between them. Enough so that my Engineering Mind is confident that the latest and greatest valve offering in the Mechanical Valve Market (On-X) offers improved performance (and lower Clot Risk) for MY issues.

Are you familiar with StretchL's story and his quest for the Best-of-the-Best Ross Procedure Surgeon? Without HIS driving force, he likely would have NEVER had that procedure and never been referred to that surgeon in New York from his home region.

He spent a full Saturday afternoon interviewing the surgeon and concluded that THIS surgeon was a MASTER of the Ross Procedure. He even posted a Photo-Journal of his surgery which the surgeon agreed to allow.

We also have members who insisted on Tissue Valves of various types when the 'standard guidelines' recommended Mechanical Valves for most patients. As you noted, it comes down to a matter of Patient Education and Personal Preferences.

Or as you concluded:
"I think it's a matter of comfort, confidence, and choice".

See, we weren't so far apart after all

'AL Capshaw'