Valve re op/ on x durability/ life expectancy etc!

[markp66]

Hi all

this is my first post. First of all I'd just like to say what a great site this has been over the past few weeks.

I had my aortic valve replaced (with a 23mm mosaic prosthesis) four years ago and looks like I will need another replacement (mean grad of 50mm) very soon. Never thought this would happen so soon.

Im only 27 years old and I'm definitely going to go mechanical this time. From what I can see the on x valve seems a good choice although I haven't spoken to my surgeon in any detail at present. Any feedback would be great. Any idea how long the on x is meant to last (hard I know as it's not been around long enough to stand the test of time). I'm from the UK and from what I can see the on x valve doesn't seem to be as well used as the U.S?

I'm hoping the valve will last me a lifetime or at least a good 20-30 years before a 3rd reop. As this is my 2nd op I'm slightly worried about the risks of this although from what I've read it seems to be much more common these days.

Are there any 2nd/ 3rd/ 4th AVR on this site? How was it for you?

I promised myself that I'd marry my girlfriend, have kids and be around to see my grandchildren. From what I have researched and seen there is no reason why this can't happen. I expect to live a long life although the recent news of another valve replacement has clearly been a set back. Any encouragement would be great!!

Thank you so much and look forward to hearing from you all soon.

Mark

 

[neil]

re ops are more or less the same risks involved so you should be fine, am sure our on x friends will be along to give you some info etc.............welcome aboard fellow brit

 

[RobThatsMe]

Hi Mark,

Welcome to the site. I had a 2nd valve replacement surgery almost 1 year ago, and selected an On-X valve to replace the St Judes that I had for the prior 10.5 years. I believe that most mechanical valves are designed to last a life time, but that does not rule out that the body will let it. If the body rejects it, by for example growing pannus around it, then the body itself is restricting the valve from functioning. Some folks are prone to pannus, and many are not.

There has been some real deep dive reports on here regarding On-X preformance. Do a few searches on this site and read some of these threads and posts. I think you will find a lot of information on your question.

Rob

 

[markp66]

Thanks so much for the info. From what I have read the on x valve is good in terms of little pannus growth. Also the potential for a lower warfarin intake in the future makes it stand out.

Rob, was there a reason you went for the on x? Do you find it noisy? Sorry for all the questions. I'm just trying to get feedback from as many people as possible.

Cheers.

Mark

 

[Julian]

I'm sorry Mark about the recent tissue valve failure. For what's it worth I'm 28 and having an On-X valve put in as well as a dacron graft. I've done my homework and think the On-X would be the best choice for me. Most of, if not all of the newer mechanical valves on the market are great, and probably have the chance to tolerate lower INR levels as well. As you already know the cool thing about the On-X is that there are some official testings being done to prove this, which by the way is going very well.

As far as multiple surgeries there are many people on this forum that have went through multiple heart surgeries, I'm sure they will chime in soon. From what I've read on this forum about the On-X being quieter then other mechanical valves... There is a mixed response, some say other mechanical valves they've had in them were quieter. Its hard to say so many things are involved with how much you notice the ticking sound. My surgeon has put in many types of valves and he said that his patients and colleagues have commented on how the On-X was a bit quieter then others. As I said before my surgeon has put in many valves and usually works with the carbomedics valve but also feels comfortable with the On-X so he's not an On-X fan boy just giving an honest observation.

 

[Shirley Dickey]

Hi Mark ,
I have only had my new On-X mitrial for 33 days and its suppose to be able to use less blood thinning meds , my surgeon told me it should last for 20-30 + years..And I can hear mine if I get angry , excitied ,emotional or in a quiet room.Its not loud but is noticibale , however my family hears it more than me. My surgeon said it will quiet down after I have had it for a while. This all the info I can provide...Good Luck and God Bless

 

[dick0236]

.....I promised myself that I'd marry my girlfriend, have kids and be around to see my grandchildren. From what I have researched and seen there is no reason why this can't happen. I expect to live a long life although the recent news of another valve replacement has clearly been a set back. Any encouragement would be great!!
Mark

Hi Mark. I already had my wife and two small kids when I got my valve and I have seen them grow to middle age men....and four grandkids from 10 to 26 and three little great-grandkids:biggrin2:......on one valve, that by todays standard, is a dinosaur:wink2:. As was posted earlier, mechanical valves have a design life much longer than our life expectancy. Problems that cause mech valves to be replaced usually are due to factors other than the valve "wearing out".

Like you said, this is the best site I have ever found for information.....and I am glad I found it 4+ years ago.......after wandering around trying to find ANY good info for four decades:confused2:.

 

[Greg a]

Hi Mark, just wanted to say hi and WELCOME TO THE FAMILY

 

[RobThatsMe]

Thanks so much for the info. From what I have read the on x valve is good in terms of little pannus growth. Also the potential for a lower warfarin intake in the future makes it stand out.

Rob, was there a reason you went for the on x? Do you find it noisy? Sorry for all the questions. I'm just trying to get feedback from as many people as possible.

Cheers.

Mark

Hi Mark,

I chose the On-X for a few reasons, (1). My first valve was a St. Judes. I do have Pannus, and it needed to be replaced. So, I wanted to try something else. (2). My surgeon at the Clevelland Clinic, highly recommended the On-X, and he was a St Judes guy in the past. He told me that now he really prefers the On-X.

Like others, I do notice my valve at times, but I also noticed the St Judes at times. That being said, I do think that the On-X is perhaps is more loud than the St. Judes at times. BUT... I also have a lot more things installed internally that can now cause that noise to echo at a louder level, such as my coiled aneurysm, and my stent with 22 cm of dacron tubing. For sure that tubing in itself has to be a sounding board. All this being said, you do get used to it... and as the body heals and recovers from surgery, the sound also seems more quiet.

How about some others comments on this. Did you find that as you healed the sound of your new valve decreased, or is this just a perception because you got used to it?

Rob

 

[ken taylor]

My onx was loud at first but now 8 weeks post AVR for som reason it getting to where I do not even notice it . And if you can take a vitimin pill once a day you can take the warfarin NO BIG DEAL!!!!!

 

[normofthenorth]

There's an interesting thread here, started by Pem, comparing the clinical results from the On-X and the ATS (now Medtronics) Open Pivot valve. I think the comparison's more interesting than you might guess. The title's something like "On-X, the truth is out there." Pem "proved" that the ATS got better clinical results overall (and several studies say that it's the quietest), and he just got an ATS of his own a few days ago. But somebody here -- dtread, IIRC -- recently posted some new contrary evidence that Pem and I haven't checked out yet.

Pem compared the two research studies for the US EPA, and found that the ATS patients were in worse shape (NYHA Class-wise) going INto their HVRs, but in MUCH better shape after they got their new valves. Dtread looked at other numbers in the same two studies and found better mortality among the On-X patients. (It's conceivable that both conclusions are correct, but I haven't confirmed that yet. (The NYHA classifications include some human judgment, too -- especially compared to mortality!)

If you want to read it and can't find it, post here, and I'll post a link.

As others have said, the actual longevity of a modern mech heart valve probably doesn't deserve any worry, though there are still lots of other reasons to need future OHS, etc.

 

[markp66]

Thanks for all the useful info so far. And Dick, thanks, you have given me much more confidence. I hope that my future valve will last me 30+ years before thinking of any other surgery etc. I've also read the thread "On-X, the truth is out there." Very interesting and both valves seem to have their plus sides.

The noise is my main concern with the on x but if it gives me a near normal life expectancy or 30 years without a reop then I'm not going to complain!

Thanks again.

 

[Chris M]

Hello Mark, I'm one of the few Brits on here.

I'm sorry to hear you need a re-op so soon, that must be so disappointing. But your choice of mechanical this time round is good... in theory it shuld last you a lifetime. I had my mitral valve replaced a couple of months ago with a mechanical valve and at the follow-up 7 weeks later I was delighted to hear my surgeon confirm that all was good and that I now have the same life expectancy as I would have had with no heart valve problem.

The surgeon should explain the risks to you in detail. I'm sure re-ops are only marginally riskier than first time ops, and probably quite low for you as you are still quite young and presumably in reasonably good health otherwise.

One further point I wanted to raise... I don't know whereabouts you are, and options may be different in various parts of the country, but I'm afraid I had no choice about which valve I had other than the basic tissue/mechanical choice. I suspect it may be the case that most UK valve patients just get whatever brand/model their local NHS authority orders in. In my case I got a Carbomedics valve, and a big one at that, but I'm delighted to say it is practically silent, I only rarely hear it and only then in exceptionally quiet circumstances. I only mention my UK experience because I see you are interested in a particular valve, one that may not be widely used over here (though I don't know that for a fact). Just be aware that that option may not be available to you as we don't usually get to "shop around" here for surgeons and valves like our American friends do.

Having said that there is nothing stopping you from pushing for what you want, it might just work if you can come up with compelling research and evidence for the product you are interested in.

Either way I wish you good luck!

 

[markp66]

Hi Chris
Yes, very annoying!!! However, not much I can do about it although I'm keen not to have a 3rd reop within the next 30 years!! (OHS isn't the most enjoyable of experiences as you know!).
I will get a better understanding when I speak to my cardiologist. I'm hoping for the on x valve and if I can't get it through the NHS then I will try private. However, I'll obviously take into consideration what they say, they are the experts after all!
Thanks for your help. I'll keep you posted anyway.
If anyone from the UK has had an on x valve could you please get in touch! Thank you.

 

[sensei Ade]

Hi Mark,
I'm a fellow on-X man based here in the UK. I previously had a tissue valve that conked out within 5 years, but now I'm doing OK generally apart from a few palpitations as things are settling down. The On-X valve is designed to last 200 years so this should just about cover it !! I was 37 when I had my tissue valve, the bloody doctors don't tell you that such valves can fail, especially in the younger fitter generation! Re: seeing your grand kids, you absolutely will be there. Take care from a fellow Brit.

Sensei

 

[LeakyUK]

Hi Mark, Like Chris I was offered the choice of mech or tissue, the mech being carbomedics. I am more than happy with it. Do not get too hung up on brand - the valve makers make HUGE profits in the US so they all use spin to try to prove theirs is the best. I take part in consumer surveys eg for razor blades, yoghourt drinks etc and I am no longer impressed by the 'new improved' line. See what you can get but you are FAR better off with a valve your surgeon is happy with, and the UK does have a very high success rate.

I also think tissue valves are oversold in the US because of the potential profit from re-ops, but thats a rant for another time.

As for warfarin, my INR has been in range for the eight weeks since my op, and I have just moved to fortnightly tests (started twice a week).

 

[ElectLive]

I don't have official results, maybe someone else does, but I know the On-X went through some sort of accelerated "pulse duplicator" testing (opening and closing, as would happen in the body) here in Atlanta (Georgia Tech) and lasted the equivalent of 100 years. It was intentionally stopped at 100 years, perhaps it was tested to 200 elsewhere, but doesn't much matter, huh...

Any high level surgeon these days seems to be saying no additional risk for operation #2, assuming otherwise good health or additional age related factors. A few on this forum have actually posted that the second surgery was easier.

You sound like you have a great attitude, and with age on your side, plenty of reason to stick to all those personal goals. Just keep posting here, and maybe one day long in the future, you'll be telling another 27 year old that a mechanical valve lasted you 60 or 70 years...

 

[neil]

good luck mark, there are people on here who have had on x in england, hopefully there will get in touch. leaky what a odd think to say about the usa choosing tissue to make more money? wheres the hard facts on that remark?

 

[pem]

There's an interesting thread here, started by Pem, comparing the clinical results from the On-X and the ATS (now Medtronics) Open Pivot valve. I think the comparison's more interesting than you might guess. The title's something like "On-X, the truth is out there." Pem "proved" that the ATS got better clinical results overall (and several studies say that it's the quietest), and he just got an ATS of his own a few days ago. But somebody here -- dtread, IIRC -- recently posted some new contrary evidence that Pem and I haven't checked out yet.

Pem compared the two research studies for the US EPA, and found that the ATS patients were in worse shape (NYHA Class-wise) going INto their HVRs, but in MUCH better shape after they got their new valves. Dtread looked at other numbers in the same two studies and found better mortality among the On-X patients. (It's conceivable that both conclusions are correct, but I haven't confirmed that yet. (The NYHA classifications include some human judgment, too -- especially compared to mortality!)

If you want to read it and can't find it, post here, and I'll post a link.

As others have said, the actual longevity of a modern mech heart valve probably doesn't deserve any worry, though there are still lots of other reasons to need future OHS, etc.

IIRC, I was actually aware of the mortality difference that favored On-X over ATS (now Medtronic). I don't remember exactly why this didn't dissuade me from ATS, but I think it was because the difference did not seem significant and could have easily been site or population related (this may have also come from the FDA studies). The NYHA results were significantly different. At one time I thought I would get the On-X but at the end of my due diligence my overall impression swayed me toward ATS. I think On-X is more sensitive to the surgeon's valve-specific experience as they tend to size differently than other valves. In the right hands OnX seems like a good choice and indeed there are many on this site who are very happy with their On-x. ATS was the right choice for me, but some of my best friends are OnX-ers

By the way, my valve is very quiet.

Best
Pem

 

[Gail in Ca]

I've had 3 surgeries. My 2nd one was a bit rough, as I was in CHF with BP of 90/19 going into the surgery.(My pig valve was deteriorating rapidly). That's when I got the Carbomedics AV. I was told by my cardio that it would last my lifetime. Oh well, it didn't because I got bacterial endocarditis from a frigging staph infection after only 8.5yrs. The bacteria attacked the tissue around the mechanical valve and also ate little holes in my mitral valve. So, after being very ill from the endocarditis and having to be treated with IV antibiotics for 6 wks, I was scheduled for my 3rd OHS. My surgeon was concerned and I was concerned about having another surgery. But, I must say, I came thru this last surgery better than the 2nd one. It was a more difficult surgery, due to lots of scar tissue that the surgeon had to deal with, a 12 hr surgery. So, now I am hoping my 25mm Carbomedic valve (inside hemashield graft) will last my lifetime!
I find it more noisy than my last valve, because it is bigger? It really thumps, especially at night. It seems only my cardio can hear it during my check-ups. It does bug me still, now over 2 yrs. But, I am slender, so maybe that's why it's more noisy for me.
So sorry your tissue valve petered out so early. But, another surgery should be fine for you, especially if you are healthy going into it! Choose a surgeon that exudes confidence!