On-x valve w/aortic aneurysm repair or replacement

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JeffM35

Member
Joined
Apr 21, 2008
Messages
6
Location
Central NJ
So my time draws near, my aortic valve has neared the end of its useful life, but at 34 the rest of me isn't in the same dire straights. I've done a lot of reading over the years, especially here, and have developed an unfortunate (?) bias toward the MCRI On-x valve. Not even so much for the hope of one day being on a no-cumadin regiment, but for the other obvious benefits, not the least of which is that extra potential safety factor if INR levels were to suddenly spike, etc.

In any event, my aortic root has been measured over the past several years by both Echo and CAT scan, numbers have hovered in the 4.8-5.2cm range. Having never had any measurements in my younger years, and given the fact I'm a rather large stature person to begin with (6'4, 280lbs, size 15 shoe, you get the picture), my cardio has been on the fence, watching for any increase in size of the aorta. While the aorta has not appeared to grow in size (in fact, because of the tolerance in measurement techniques w/non-invasive analysis, it hasn't changed at all), the LV is finally showing first signs of minor increase in size, so its time to replace the valve.

I'm guessing there's an excellent chance the surgeon will also want to repair / replace the aorta while doing the valve because of the size of the aorta, and my question is this. I realize MCRI does not currently offer the On-X with prefabricated dacron, does anyone know of increased risks (other than increased time on bypass) with insisting that my surgeon use the On-X w/field installed dacron?

I feel strongly enough compelled to have an On-X valve used for my surgery, I'm in a frame of mind where I will seek out a surgeon that will at least make every effort to make sure this is what is used (of course, barring any complications that would further contraindicate at the time of the actual procedure).

If any one has any further info on this I'd really appreciate it! And thanks everyone for sharing stories, opinions on this site. Its been great reading over the years!
 
Hi Jeff and welcome.

Someone just had it done last month I beleive. Give it time for the person to see and respond. I can't remember who. :(
 
My son is one that had it done and I know there have been others here. My son (as you can see from below) has gone through a lot. His doctors are very protective of him and they were very comfortable with the field installed graft. His surgeons words were "it'll probably take me an extra 5 minutes".
 
Welcome Jeff. I can't help you with your question, but I can put you on the calendar so be sure to let us know when you have a date. We like to help you over the mountain as well in preparation for the climb.
 
I once asked Catheran Burnett, the Manager of Education for On-X (and former surgical RN at Baylor) about providing an attached graft. As you noted, it is not yet available, BUT, her response was that an experienced surgeon could make an attachment in about 3 minutes (on the same order of magnitude as Brian's surgeon's estimate) with NO assistance and practically NO increase in pump time with an assistant.

You can call Catheran at 1-888-339-8000 ext. 265 if you wish to discuss this issue (or any other) further. Or write to her at [email protected]

'AL Capshaw'
 
Hi Jeff,
Just wanted to pop and and tell you that I had my aortic valve replaced last fall with an ON-X valve. I also had my ascending aorta replaced with a dacron graft. My surgeon said it didn't had much to the time I was on the heart lung machine.

Almost 8 months post-op and everthing is working fine.

I wish the same blessings and good luck to you!
 
On-X

On-X

Jeff,

I was wondering if there was any update since your last post.

My surgery for AVR and root repair is scheduled for July 2008 and I've been lobbying for the On-X due to the anti-coagulation trials they're running.
 
Extra Time

Extra Time

The On-x was my first choice when I had my AVR surgery in March 2007, but my surgeon strongly recommended a St Jude with the factory installed Dacron conduit. We had talked about the potential issues associated with additional time on the heart-lung machine and I wanted off it as quickly as possible.

I doubt having an On-x with a field installed graft would have increased the amount of time I was on the machine significantly, but I was still really worried about it. I was and still am comfortable with the choice that I made and that comfort issue is very important as you make your choice. If you have confidence in your surgeon, and an On-x with a field installed graft is what you want, that's the one you should opt for. A number of folks here have had it done and they're doing just fine.

As I looked at the On-x, one of the attractive elements was the research indicating that the valve does less damage to red blood cells than other valves. Less damage is a good thing.

-Philip
 
Just an fyi, i went the other way and took the st jude with factory attached graft.

Just wasn't that bothered to take the additional risk.

It's not just the additional time under but the fact that there are stiches holding two man made fabrics together......not a great waterproof seal for my liking.

But like everyone says, it won't make that much of a difference.

Good luck.
 
180

180

After consulting with several surgeons (CCF, RWJ) and my own research and analysis, I've done a 180 with my whole view. The sole reason I would opt for the ON-X is the lure of low/no coumadin therapy. I'm not looking to start a debate, I know its a touchy subject, and I fully support both sides of the argument for/against the whole 'living with coumadin' thing (which only makes it that much more difficult to make the decision), but I'm going with a tissue valve which carries the greatest chance of no need for coumadin. If the trials don?t prove successful, then for me the ON-X would be of no benefit over any other mechanical valve ? in which case, I?d probably choose a mechanical valve that has more proven history and follow up (ie. St. Jude, etc.) ? again, not looking to start a debate over this, this is just my opinion. Of course, I make this decision putting my chips on the tissue valve assuming I can get 10+/- years out of it before need for re-op (with latest generation bovine valves, claim is that even at my age its very likely 15+ years according to advice of two separate surgeons), and assuming that's the case I'll reassess where I'm at then, where advancements have gotten to if any where significant, and then go through the whole process again. If by then the ON-X trials have concluded and things are positive, the decision for replacement of my then defunct tissue valve will be one of the easiest decisions I ever make. I?ve always been quick to heal, have a very high tolerance for pain, so knowing I?m guaranteed a second surgery in ~10 years isn?t something I can?t deal with (of course, I?ll let you know my view on this after this surgery when I can comment from experience!).

Best of luck for everyone else going through the same process of choosing their path. I don't have a date set yet, but within the next few months. I'll be sure to check back in before and follow up after. Its the least I can do, considering the best counseling I've received throughout my journey so far has been reading the experiences of others who have gone through this.
 
I had an on-x valve put in with a dacron graft just over 2 weeks ago. I feel great! I don't really have much info to add. This is already my second surgery and I REALLY didn't feel like going through this again, so I went with the mechanical valve. The warfarin therapy has been a bother, but it's not that big of a deal. I will be extremely happy when my INR home testing machine arrives.

best of luck!
 
After consulting with several surgeons (CCF, RWJ) and my own research and analysis, I've done a 180 with my whole view. The sole reason I would opt for the ON-X is the lure of low/no coumadin therapy. I'm not looking to start a debate, I know its a touchy subject, and I fully support both sides of the argument for/against the whole 'living with coumadin' thing (which only makes it that much more difficult to make the decision), but I'm going with a tissue valve which carries the greatest chance of no need for coumadin. If the trials don’t prove successful, then for me the ON-X would be of no benefit over any other mechanical valve – in which case, I’d probably choose a mechanical valve that has more proven history and follow up (ie. St. Jude, etc.) – again, not looking to start a debate over this, this is just my opinion. Of course, I make this decision putting my chips on the tissue valve assuming I can get 10+/- years out of it before need for re-op (with latest generation bovine valves, claim is that even at my age its very likely 15+ years according to advice of two separate surgeons), and assuming that's the case I'll reassess where I'm at then, where advancements have gotten to if any where significant, and then go through the whole process again. If by then the ON-X trials have concluded and things are positive, the decision for replacement of my then defunct tissue valve will be one of the easiest decisions I ever make. I’ve always been quick to heal, have a very high tolerance for pain, so knowing I’m guaranteed a second surgery in ~10 years isn’t something I can’t deal with (of course, I’ll let you know my view on this after this surgery when I can comment from experience!).

Best of luck for everyone else going through the same process of choosing their path. I don't have a date set yet, but within the next few months. I'll be sure to check back in before and follow up after. Its the least I can do, considering the best counseling I've received throughout my journey so far has been reading the experiences of others who have gone through this.

Good luck my friend, this one will knock your sails down some. :cool:
 
So what kind of thinner reduction is expected with the On-x valve? Are they thinking no blood thinner at all for the on-x?

I saw on their website they reference this forum as an info source. That's pretty neat.
 
There is a clinical trial on-going at about a dozen hospitals with the On-X valve. From what I understand there are 3 different types of groups within the trial. All have an On-X valve in the Aortic position and group 1 is taking Coumadin, group 2 is taking Plavix (I think), and group 3 is taking only a baby aspirin. They are going to follow these groups until 2014 or 2015 and see how the valve hold up I guess. Since I have an On-X valve I am very interested in this study. However I wasn't brave enough to participate. The ideal end-game would be the folks who are on the baby aspirin only have a comparable clot/stroke rate as those who are on Coumadin. And from what I've read thus far the clot/stroke rate for On-Xers is extremely low.
 
Someone on the forum is taking part in the trial. I wanted to, but I didn't have enough time prior to the surgery to get in.
 
I don't know about letting my surgeon practice his sewing on my aorta graft... sounds kinda iffy.

Does anyone know the failure rate in accelerated tests on these things? Or even the mortality statistics so you can compare them to valves like the st. jude and etc?
 
On-x

On-x

I'm in the study here in Maine.

The three groups here are 1.) Normal dosage level of coumadin. 2.) Reduced dosage level of coumadin. 3.) Plavix and baby aspirin.

I had my aortic valve repaced with theOn-X valve in June 2007.

When I opted for the On-X, I signed up for the study, and started out with coumadin at the normal dosage.

Three months after my surgery I was chosen to be in the Plavix/Aspirin group.

Once a day I take 75 mg of Plavix, and a baby asprin. I've had no problems or side effects from this regimin. Next month I go in for a semi-annual echocardiogram.
 
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