After 13 years in the "waiting room", surgery date is set for June. Let me know if agree with my plans...

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BillDaThrill

BillDaThrill

Well-known member
Joined
Apr 17, 2016
Messages
86
Location
Los Alamos, NM 87544
Had a bunch of time to figure this out. Am curious to hear your opinions of my plans. Am traveling 1600 miles to have surgery (aortic valve replacement/ascending aorta replacement) at the Cleveland Clinic with Dr. Lars Svensson. At age 52 and pretty active outdoors (ski patroller, mountain biker, volleyball, hiking) am planning on a mechanical valve as I only wish for a single surgery. Thinking On-X valve but thinking the St. Jude would be an excellent one too. Fire away!!!
 
BillDaThrill said:
...Thinking On-X valve but thinking the St. Jude would be an excellent one too. Fire away!!!
Click to expand...
dunno if you saw this post but it would seem that the On-X does not match its claims when installed, unlike St Jude

https://www.valvereplacement.org/threads/aortic-valve-choices.887840/post-902334
my ATS also is inferior but I'm not about to swap that out in any rush ;-)

I'm only posting this in the case that you have a desire for some particular aspect of specification.

:-D
 
I have a St Jude Regent, my fathers St Jude was implanted in 1985 and is still ticking away so I see that as an excellent legacy for St Jude.
I could be wrong but I seem to recall reading the founder of Carbomedics was a co-founder of St Jude valves back in the late 70s (?), so both valves origins are cut from the same stone so to speak.
 
I’d take either valve. I’m sure they’re both fine. I have the St Jude. The only thing I wouldn’t do is try to dance between 1.5 and 2.0 on my INR. 2-3 and minimum. I stay between 2.5 and 3.5 myself, perhaps based on dates recommendations. But clots scare me more than bleeding events.

I can get a shot of vitamin k. Hard to stop a stroke and reverse damage once it’s started.
 
BillDaThrill said:
Had a bunch of time to figure this out. Am curious to hear your opinions of my plans. Am traveling 1600 miles to have surgery (aortic valve replacement/ascending aorta replacement) at the Cleveland Clinic with Dr. Lars Svensson. At age 52 and pretty active outdoors (ski patroller, mountain biker, volleyball, hiking) am planning on a mechanical valve as I only wish for a single surgery. Thinking On-X valve but thinking the St. Jude would be an excellent one too. Fire away!!!
Click to expand...
Welcome. I totally agree with your decision. I had the same facility, surgeon, procedure, and age for surgery #1 (ascending aorta) and same for #2 last month and got the On-X.
I was fine with either the SJR or On-X and left it up to Lars to decide which was best for my specific anatomy. I suggest you do the same as he is the expert. He is very precise and quick.
Did he recommend a full sternotomy? I'm curious where you're coming from? Sounds like Colorado. Love it out there!
 
I also agree that, at age 52, a mechanical valve makes the most sense. It will give you the best chance of "a one and done" valve replacement with little impact on your activities. Like the earlier posters I would not attach a lot of importance to the lower INR marketing.
 
Unicusp said:
Welcome. I totally agree with your decision. I had the same facility, surgeon, procedure, and age for surgery #1 (ascending aorta) and same for #2 last month and got the On-X.
I was fine with either the SJR or On-X and left it up to Lars to decide which was best for my specific anatomy. I suggest you do the same as he is the expert. He is very precise and quick.
Did he recommend a full sternotomy? I'm curious where you're coming from? Sounds like Colorado. Love it out there!
Click to expand...
Appreciate that! Have not learned of details of surgery with respect to incision size or approach - just his recommendation to replace valve and ascending aorta. Yes, plan on leaving it to the Doc but figure I better to my research (and ask about the Inspiris Resilia valve too). Good guess on CO, but 100 miles south in New Mexico living at 7300 ft elevation.
pellicle said:
dunno if you saw this post but it would seem that the On-X does not match its claims when installed, unlike St Jude

https://www.valvereplacement.org/threads/aortic-valve-choices.887840/post-902334
my ATS also is inferior but I'm not about to swap that out in any rush ;-)

I'm only posting this in the case that you have a desire for some particular aspect of specification.

:-D
Click to expand...
Yes Pellicle had seen that prior post and found it incredibly interesting. As a mechanical engineer, I like seeing the Reynolds' number calculations. It was a single study and I hope to do some more digging into the reported On-X oscillation. Some of the references cited in that study might be interesting to read. I understand yours and others positions that On-X appears to be more of a marketing hype than anything else, but also know that many folks with On-Xs note excellent results. I will definitely speak to the Cleveland Clinic about flow dynamics between the two valves. Looking forward to learning more from you about INR maintenance post-surgery.
 
BillDaThrill said:
Appreciate that! Have not learned of details of surgery with respect to incision size or approach - just his recommendation to replace valve and ascending aorta. Yes, plan on leaving it to the Doc but figure I better to my research (and ask about the Inspiris Resilia valve too). Good guess on CO, but 100 miles south in New Mexico living at 7300 ft elevation.
Click to expand...

I strongly suggest that you have your mind made up between Tissue vs. Mechanical before going there. Lars did recommend the Inspiris to me first. Then I asked how long he thought it might last in me, answer; "maybe 8 to 10 years but could be more or less". No thanks!
I wanted one and done. So, narrowed down to 2 choices. Both are good.
If you have a stenotic aortic valve I bet you're getting dizzy at that altitude.
 
BillDaThrill said:
understand yours and others positions that On-X appears to be
Click to expand...
My position on that centres around the INR issue, not the valve quality or longevity.

It's a sad aspect of these places that everyone assumes posters have binary polarised views.

Just today I got a reply from an old thread where I was essentially accused of that while in that post I was making the point that at the age of the question asker either tissue or mechanical would be very similar in outcomes
 
Superman said:
I’d take either valve. I’m sure they’re both fine. I have the St Jude. The only thing I wouldn’t do is try to dance between 1.5 and 2.0 on my INR. 2-3 and minimum. I stay between 2.5 and 3.5 myself, perhaps based on dates recommendations. But clots scare me more than bleeding events.

I can get a shot of vitamin k. Hard to stop a stroke and reverse damage once it’s started.
Click to expand...

I want to emphasize what is stated in this post.

Please don‘t fall for the marketing ploy of an INR of 1.5-2 for the ON-X valve (don‘t ask me how I know...) and stay at the safe 2.5-3.
 
BillDaThrill said:
Had a bunch of time to figure this out. Am curious to hear your opinions of my plans. Am traveling 1600 miles to have surgery (aortic valve replacement/ascending aorta replacement) at the Cleveland Clinic with Dr. Lars Svensson. At age 52 and pretty active outdoors (ski patroller, mountain biker, volleyball, hiking) am planning on a mechanical valve as I only wish for a single surgery. Thinking On-X valve but thinking the St. Jude would be an excellent one too. Fire away!!!
Click to expand...
Your plan sounds very good to me. I am 53 and will be getting my first, and hopefully only, aortic valve surgery in 4 days at UCLA. I spent a lot of time trying to decide between tissue and mechanical, and came to the conclusion that mechanical is right for me, as I want to be one and done. I have a very active life, and have been convinced that I can continue to have a very active life.

I am going with a St. Jude. My surgeon prefers the St. Jude and is of the opinion that the claim that the Onyx can get by with a lower INR is not supported by the literature. That seems to be the predominant view on this board as well. I like that there is solid 30 year outcome data for the St. June. Having said that, I think that both the St. Jude and Onyx are probably good valves and many here have had each of them and are happy with theirs.

You commented on the Resilia. Initially this was my valve of choice, but like another poster, when I learned the expected life of a tissue valve for someone in our age group there was no way that I would go that route. There is hope that the Resilia will last longer than other tissue valves, but there is no data yet to support that it will. I really want this to be my last OHS.

I have heard nothing but great things about Cleveland Clinic and Lars Svensson. I believe you will be in good hands.

Best of luck!
 
I had my operation in my home city with a local team of doctors, nurses and rehab specialists. I was about the same age and chose mechanical. I have no trouble keeping my INR in the recommended range of 2-2.5. I got a St. Jude because of my surgeon's recommendation. He would have installed either, but likes the St. Jude because it's "rugged" and has a long history. My only regret is the mechanical valve does not allow me to routinely take NSAIDs (I have developed arthritis). But that's a small price to pay for avoiding future open heart surgeries.

I'd make sure you have good follow-up care at home since you've decided to have your surgery elsewhere. In my case, my team after surgery included a surgeon, surgeon's PA, a PT, a cardio and cardio's RN. When I started cardio rehab I got an additional rehab PT and RN. At home:
  • You will need to be tested regularly for INR and get dosing help.
  • After a few weeks you will need an Xray to check the chest and get released by your surgeon.
  • Follow-up care should include cardiac rehab. Even if you know how to exercise, cardio rehab helps you start small and work up to the full monty. It's also reassuring to have an expert RN or PT to ask questions of twice a week.
  • Make arrangements to assure your relevant records get transferred from the hospital to your home base doctors.
 
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