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Roger - What does your doctor mean that St Jude's is the low bidder? If he is referring to hospitals choosing to go with St Jude's because it costs them less, that could be true in some areas, but not in all. In Houston, most large hospitals have several types of valves available depending on the surgeon's preference. They would never tell the surgeon to use a particular valve because it is cheaper, and if they did, the surgeon wouldn't listen. He's the expert and not on their payroll. I guess it could be different in states where the surgeons are employees of the hospital or hospital system, but here they are independent. Still St Jude's is the most popular. It's just been around a long time and surgeons are comfortable with it and know it's proven - not necessarily better than all the others, but definitely as good (according to the surgeons I've spoken with).

Most insurance companies in this area reimburse hospitals for implants, either directly or through a carveout for valve surgery. If it's indemnity, they pay a percent of charges. If it's managed care, it's in the fee schedule. I know because I negotiate hospital contracts for a large insurance company. I've also negotiated contracts for a large hospital, and I can tell you that we made sure to get reimbursed from the payer for valves and other high cost implantables.

skeptic - As of now, Mr. Magoo states that he used to be in the heart valve business. He mentions several brands in his post, but hasn't come out in support of any one in particular. He could simply be marketing against the On-X, but in his words..."A patient who gets an SJM , CMI or ATS is absolutely as well served as one getting an On-X valve." He said that the real success lies in the hands of the surgeon, something that none of us will argue with.
 
My previous response, "Bravo" did not mean that I agreed with Magoo's entire post but rather an applaud for the way it was written. It would appear that he has a lot to offer this site.
 
Seems to me putting the survey up has sparked a thoughtful discussion, which is a plus in itself. We can all see that there is a corporate sponsor; that's out in the open and above board. That being the case, I see nothing wrong with it. We are all big boys and girls and we can make our own decisions.
 
The best option for my AVR was a State teaching hospital. (which was highly recommended by my cardiologist and I was treated excellent!) Most State institution's secure operating supplies from an open bid process, heart valves must not be an exception. I had to request the On-X valve...right or wrong I'm stuck with it for the duration.

As a side note... I also noticed when I switched from their *contract* Metroprolo to my pharmacy's version my heart rate decreased by 10 BPM. I'm convinced that all generic meds are not created equal...
 
Thanks for the comments on my initial message and the opportunity to respond.

From Hank: You have lots of comments, but few suggestions as to what is a better way. Lets discuss :)

My post was intended to include just that; several suggestions on how better to go about selecting a mechanical valve. Choose a good surgeon at a good institution and don?t let internet word of mouth or viral marketing confuse good science.

From Hank: If ANY valve manufacturer were to come to me and want to publicize their product in such a way that it educates patients about valve replacement surgery and valve options... And then gave me full disclosure of what that process consisted of...

And this from the On-X survey: You must be willing to share your personal information including name, address, E-mail address, your telephone number, valve information, surgeon name and surgeon telephone number with On-X Life Technologies, Inc., in order to participate.

From Ross: I don't see how a valve survey is in anyway a marketing ploy.

Let me explain why this is absolutely an overt and intrusive marketing ploy. In their ?full disclosure? did they tell you that in buying the above information from patients, they are gaining a significant and valuable sneak peek at the upcoming national valve replacement surgery schedule? Did they disclose that they will be able to target surgeons with their sales efforts? Think about it. A patient participates in the survey, provides the above information and subsequently brings up the valve to their surgeon. At the same time, the company has the survey information and lets their sales rep know that Surgeon X ought to be a high priority on the sales call list so the rep spends more time chasing the surgeon around the hospital trying to raise interest and visibility. It is a timing thing. In a perfect world from the valve company?s standpoint, some surgeons will give it a whirl. If you are the patient, you may have succeeded in becoming one of the surgeon?s first implants of that type and the company will be very appreciative that you helped them get a new customer. If you want to be a trailblazer, have at it. If you don?t, I urge you to reread my opinions on minimizing risk and remember that you take the risk; they get the benefit.

From Skeptic: Out of curiosity, I would also like to see a citation on his assertion that the ON-X valve is "challenging" to implant.

I will admit this is anecdotal. I would direct you to the various company websites where one will note the differences in design. Successful surgery depends much on routine, muscle memory, feel and judgment. Things that alter those, such as implanting a new valve, can change the risk profile. I am not saying it is a guarantee of a problem; only that it increases the possibility of implant problems until they get used to the valve. Sometimes taking the risk can be beneficial when you stand to benefit greatly, but if all mechanicals perform equally well, I would be more interested in my surgeon being comfortable and confident. Surgeons aren't keen on publishing papers that describe how they had difficulty putting in a valve, although it is not unheard of. For reasons I am sure you will appreciate, it is easier and safer for a surgeon to just go back to the valve they were using previously than publicize the fact that they had trouble.

In conclusion, by suggesting that the website had gone commercial, I didn't mean to imply that you had sold out. Just that there does seem to be a clear bias towards one company versus others and this survey plays into that in ways that may not seem obvious but undeniably exist. I was under the impession that you were trying to police those influences.

.
 
Mr. Magoo,

Thanks for leaving this debate to facts and reigned in feelings.

This is all good stuff.

I rest on my comment that other valve companies have contacted me with approaches that were more than I was willing to accept.

Other valve companies have never contacted me at all.

I firmly believe in equal opportunity for any and all valve companies to utilize this forum.

As we move forward, what better place than here for forum companies to debate the values of their products. Debates are feeding grounds for the snippets of truth that we (theelite of the patient community) can gleen from the discussions.
 
Regarding exploitation, some time ago I mentioned and eventually complained that a member here continously posted a certain valve company's contact info, even numerous times within the same thread -- it was beyond ridiculous.

(That member doesn't even have the valve that they repetitiously recommended.)

Shortly thereafter, a new member joined and suddenly began sending me PM's asking me what I thought of that same valve. It was pretty strange and I'm about 99 44/100's% sure that member was a plant. That new member was suddenly scheduled for that particular valve in question and quickly had an amazing surgery and recovery. All was happily ever after and the member disappeared as quickly as [he/she] appeared, interestingly with no pharmacy questions.

No way or no need to prove it but I suspect that hasn't been the onxly instance of a plant.
 
We need to focus on helping the individual and stop trying or looking for ulterior motives within people. I'm sure were taken advantage of quite a bit, but look at how many have been helped and have stayed around to say so. The numbers speak for themselves. :)
 
Eat the fish and spit out the bones ... there is no "pure" source, one that has "no" agenda..... As one who is probably too trusting I still enjoy and learn from those who are smarter and more informed .... there are many:rolleyes::p
 
When I was a mortgage broker, I paid 60 dollars for one live lead, meaning each person that called me directly through my marketing agent was worth 60 dollars. The only qualification was that the person calling had to meet a minimum set of criteria, like credit and job qualifications, and the obvious interest in refinancing.

Sometimes I'm a cynical guy, but I think this is an excellent marketing opportunity for On-x and worth much more than the 50 dollar pre-surgery "survey". Especially if it involves the release of medical information and the ability of on-x to contact your surgeon directly under the auspices of clinical studies, ultimately to sell their valve product to him or her. Each new surgeon under a valve manufacturer's belt is essentially a client for life, and when you tap in to a segment of patients like VR.com that go to high volume, expert centers, well I think this is an extremely lucrative proposition for on-x. Each participant is a lead. :)

I'd like to see what the objective of the study is, myself.

My two cents.
 
Thank you everyone..

Thank you everyone..

When I needed a mechanical valve implanted, I was TOLD what valve I would have. At least I was shown a little model of one in the surgeons office. I had no idea that there were more than one type.

The nature of this thread is the reason why I created this site. Discussion - Education - Knowledge - Self Awareness, etc.

There are some people on this forum who like Chevy's and no matter what Ford lovers may say - or even the fact that Ford's suck has nothing to do with the fact that people love Chevy's.

A site that lends itself to healthy discussion about the merits of Fords and Chevys and all of the other choices, is a good thing.

If someone comes on this site and repeatedly lends a preference to the On-X valve over some other valve - Then I applaud them for lending their views and adding to the resource of information that we have here.

Personally - I like Smart Cars!
 
Hank, off topic, but you started it, and this particular thread seems to be bogging down anyway, but have you seen a Smart car up close? They are starting to show up all over Houston, and I'm sorry, but driving a Weeble car on the freeway among the Texas trucks, is just crazy! Is 35 mpg really worth your life? Personally, I'll go for the International MXT Pick-Up! At $80,000 and a combined fuel economy of 12 mpg, it's a great deal! :eek: The picture is tiny, but gives you an idea. That's a Hummer it's sitting beside!
 
Dealerships....

Dealerships....

Probably not a good idea to go to the Chevy dealership to buy a Ford, huh? :eek: :D lol Not to imply this is a on-x dealership? :eek: but I bet St. Jude (or any of the rest) would give a right arm for equal time/space. :D

If you could get the valve companies to ?debate? and not just advertise? that would be great. Good luck.

It?s a slippery slope, Hank. But I?m confident you know what you?re doing. Just be careful. Those scoundrels will pull the wool over your eyes if they think they can get away with it. I feel the survey is a marketing tool. I?d NEVER give all that info to a ?survey?. It may be okay.... but I sure wouldn't do it.

I appreciate Mr. Magoo taking the time to post. He doesn?t seem to be pushing anything? except education. He appears to have a lot to offer... I hope he gets a welcome, not a bashing. I thought his post was fabulous.

Right on, Lisa! If I can?t get there on a bike trail, I?m taking my Explorer.
 
Thanks for the points made and the kind comments. To be upfront about it, if I was told tomorrow that I needed a mechanical valve, I would have a preference. There are surgeons I trust who have long successful experiences using a particular valve and I would lean in their direction. That is only scientific to a point. Science can show they have good results and that the valve works well. After that, it is simply because I have come to know and trust them. I admit that and those opinions are not of value to this forum.

If, however, I passed out in front of a hospital and woke up 48 hours later with a mechanical valve in me, my heart would not skip a beat (pardon the pun) over which valve I had. If on the other hand, I didn?t wake up and later found out it was because the surgeon who had picked up my case was trying a new valve, or procedure, or trying to be innovative, I would be asking St. Peter for a day pass so I could track down that surgeon and bring him back with me to the afterlife.

That is my perspective. More conservative. Let someone else be the early adopter. Unless, and it is an important unless, there is a genuine opportunity for a benefit. We do need courageous patients to support innovation. I shudder at comparing the marketing of cars or mortgages to heart valves. I was motivated to post here in part because of a few posts sometime ago where patients in difficult circumstances were making difficult time pressured decisions and were creating unrealistic expectations for themselves based on what they were seeing and reading on this forum. That is all I want to do. Bring some balance to the discussion so that whatever a patient decides is based on the facts as we know them.

The suggestion was made that you could have the companies debate their merits. A credo that I try to go by is this: "In God we trust. All others must show data." The data is published and most people will agree, unless they have an underlying agenda, that there is no good science to support one valve over another; all other things being equal. If that is the case, what is there to debate?

I say this part tongue in cheek, but I would drive a few hundred miles and pass four decent hospitals on my way to get the surgeon I wanted. I wouldn?t do that to get the mechanical valve I wanted. The added driving miles puts me at more risk than any benefit I could gain from one valve vs the others based on the science that is out there.

If I can help or answer a question, let me know. And further, if I am more hindrance than help, let me know that as well.
 
Some folks live for data and some don't. Depends on the person to whom your addressing. I for one, don't give a hoot about data. It either works or it doesn't work and when it comes to surgeries, no one knows what a given persons outcome will be. There can be all the data in the world suggesting the person will be fine, but I've experienced and so have others, much less then desirable outcomes then the data showed we should have had. To each his own I suppose.
 
I shudder at comparing the marketing of cars or mortgages to heart valves.


I take it you didn't like my analogy? :D I wasn't talking about the decision making process, I was trying to convey the less than altruistic component of the On-x survey.

Also, I like toyota corollas.

dscf3434po0.jpg
 
When I needed a mechanical valve implanted, I was TOLD what valve I would have. At least I was shown a little model of one in the surgeons office. I had no idea that there were more than one type.

The nature of this thread is the reason why I created this site. Discussion - Education - Knowledge - Self Awareness, etc.

There are some people on this forum who like Chevy's and no matter what Ford lovers may say - or even the fact that Ford's suck has nothing to do with the fact that people love Chevy's.

A site that lends itself to healthy discussion about the merits of Fords and Chevys and all of the other choices, is a good thing.

If someone comes on this site and repeatedly lends a preference to the On-X valve over some other valve - Then I applaud them for lending their views and adding to the resource of information that we have here.

Personally - I like Smart Cars!

Hank,When I came up for surgery I knew there were many different types of valves. I decided to allow the surgeon to use the valve he was comfortable with.In my view this is still not a bad idea. Warm regards Marty
 
Mr. Magoo thinks that valve choice should be left to the surgeon. Pick a good surgeon, and then let the surgeon decide the valve. The implication is that the “Valve Selection” forum should be changed to “Surgeon Selection”. Pick a good surgeon, who has completed at least two dozen implants of whatever valve he/she decides to use, and you’ll do okay.

I do not agree with this very conservative and quite passive position. If I did I would not have an On-X valve; I would have a St Jude.

When I became aware that I would be having a valve replacement, I only had a few weeks prior to the surgery to prepare. I was told I would be getting a St Jude valve. I went onto the Internet and went to each and every valve manufacturer’s website to see what they had; to compare with St Jude to see if they had anything that would make them a better choice than St Jude. I specifically performed my research being aware that the websites would be using marketing strategies to promote their product, and to try to “read between the lines” so to speak.

I ruled out the Medtronic Hall Easy-Fit Valve because I do not like the tilting disc design. I ruled out the ATS Open Pivot and Carbomedics bileaflet valves simply because they did not seem significantly different than the St Jude. However, when I got to the On-X website, I thought that it looked pretty interesting.

I have a Master’s degree in Marketing, and in my work in telecommunications I have dealt with many sales people and marketing strategies. I continued researching over a period of several days, specifically gathering information on St Jude and On-X. It was easy to see that St Jude is like the General Motors of heart valves, and that On-X was much smaller. However, when I looked at the data, and the other advantages of the On-X, it seemed to have many advantages; e.g.:

Lowest rate of thromboembolism
Lowest mortality rate
Highly polished hinge pivot area for less chance for clots to form
Leaflet guards to prevent pannus ingrowth

I contacted On-X to get additional information on the hemodynamics of their valve. I was particularly interested in this aspect because I have always been a fitness buff, and I wanted the best valve available so that I would have the least impairment to my fitness regimen. On-X provided me with additional information that confirmed that the On-X had hemodynamics that were at least as good, if not better than the St Jude, and with a lower mortality rate. I learned that the same person (Dr. Jack Bokros) worked on the design of the St Jude, Carbomedics, and ATS valves, and also designed the On-X. I realized that the On-X represents the latest technology in heart valves. I was sold on the On-X.

At my appointment with the surgeon I indicated to him that I wanted the On-X. At first he totally dismissed the notion, but I persisted and he finally agreed to take a look at it. He asked if I was ready to be the first, and I indicated that I was. I was willing to accept what I considered to be a pretty low risk. Right or wrong, I was going to have to live with this decision, but I wanted the best valve available. In the following days On-X contacted the surgeon on my behalf (and with my approval) and got everything set up, and sent a representative in who was present during the surgery to assist the surgeon. The day after the surgery the surgeon indicated to me that the surgery “went perfect”. I did not specifically ask him whether he had any difficulty with the implant, and he did not indicate anything unusual.

I considered being the first to receive the On-X to be low risk for a couple of reasons. For one, all the valves are pretty similar in design and implantation of one valve is not all that different than implantation of another. For another, surgeons are trained to adapt and think on their feet in stressful situations, and I do not think that implanting a new valve (to the surgeon) would add much risk to the equation. Mr. Magoo indicates a “cutoff of at least 2 dozen cases” before he would want a surgeon to implant a particular valve. This indicates to me that Mr. Magoo must have either a financial or some other interest in either ATS, Carbomedics, or St Jude. If you can believe Mr. Magoo from the “USA”, it is indicated that “in a past life I spent a couple of decades in the heart valve business”. Well, perhaps Mr. Magoo owns stock in ATS, Carbomedics, or St Jude. Or perhaps Mr. Magoo has some ties to one of these companies, is friends with present employees, or has some other relationship that ties Mr. Magoo to one of these companies. The reason I say this is that if Mr. Magoo can get future valve recipients to listen to his/her message of “let the surgeon pick the valve” and “cutoff of at least 2 dozen cases” Mr. Magoo can at least slow up, or block On-X sales. And letting the surgeon pick the valve allows sales of ATS, Carbomedics, and St Jude to continue as they have in the past. For all we know Mr. Magoo is presently in sales or marketing for ATS, Carbomedics, or St Jude, and this is simply part of his/her job. Or perhaps Mr. Magoo got snubbed in some way when On-X was formed, and has some grudge against On-X.

I believe that the way it works in most cases is that the hospital or medical center has contracts with specific medical suppliers for goods. I do not believe that most medical centers have a stock of valves on hand from Medtronics, ATS, Carbomedics, On-X, and St Jude, and the surgeon makes a decision that “I think I’ll use an ATS on Mr. Smith, and a Carbomedics on Mrs. Jones, and an On-X on Mr. Taylor”, etc. The valve choice has already been decided long ago through the contract that the medical center or hospital has, and the surgeon pretty much uses the same valve on whoever comes through for surgery. I am sure that the Chief of Cardiology had a major influence on the decision on what valve company got the contract, or it may have been decided by whoever was the low bidder, or there may have been other factors.

Subsequent to my surgery over a year ago I believe that my decision to go with the On-X valve was a wise choice. At one-year post op I was virtually 100% recovered from the surgery. My workouts in the gym (twice a week) consist of a half an hour on the weight machines (chins, dips, curls, tricep press, bench press, overhead press, butterfly, lat pull down, leg extension, abdominals, leg curl, etc.), then 15 minutes on the Concept 2 rowing machine, then 15 minutes jogging on the treadmill, and ending with 30 minutes on the elliptical machine (1.5 hours total workout). On top of that I do an 18-mile loop on my bicycle twice a week, which takes just over an hour each time. I wear a heart rate monitor, and my heart rate during workouts is usually between 140 to 165 bpm. The highest I’ve taken it to is 176 bpm for a short period on an uphill. The On-X valve has performed flawlessly in all cases. My times for the 18-mile loop on the bicycle are consistently equal to the best times I had pre-op.

Regarding the anticoagulation issue, with me it became practically a non-issue once I got on home monitoring. The side effects of the Warfarin are practically nil, and the monitoring is definitely no big deal. I do take great comfort in knowing that the On-X valve has the lowest rate of thromboembolism, and in the knowledge that there are a whole bunch of folks in Africa and Australia that have been (and are still) running around with NO anticoagulation at all. I believe that provides me with at least an extra margin of safety.

The “Articles” tab on the VR.com home page and the PTINR.com tab at the top of the VR.com forum page both take you to the Heart Valve tab of the PTINR.com website. This puts “Carbomedics” right in your face. Does this mean that Carbomedics is subsidising VR.com? This has been there as long as I can remember, but I’ve only been a member a little over a year. I don’t know that anyone raised any fuss over that, and Mr. Magoo did not mention it.

I am not an employee of any valve or medical company, do not work in the medical field, did not receive any coaching and am not receiving any compensation whatsoever for the above commentary, and do not own any stock or other interest in any heart valve company or medical concern. The above comments are not to be construed as any kind of medical advice and simply reflect my own opinions and experiences. Anybody that wants proof that I had valve replacement is free to come to the Washington, DC area and I will be happy to show them my scar and the hospital bills as proof. I also have some pictures from when I was in the hospital.

I have one question for Mr. Magoo, which I don’t think that he/she will be able to answer:

Is Lisa in Katy going to get her Massage from the Founder?
 
Dan, I am happy I allowed the surgeon to choose my valve. Ten years later at age 82 I'm still here!The St. Jude # 33MEC-10 is still clicking along. What's to complain ? I think if the On-X is really better all the surgeons would use it immediately. After all, they want the best outcomes.
 
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