Aortic Valve Choices

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jlcsn2015

Liborio
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The biggest and probably main difference betwen OnX and the others is the Fact that it opens at 90 degress, the others do not..... ask your surgeon, that is what mine told me :)
 

gpr100rs

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Michigan
There is a study underway to determine whether the On-X aortic valve can be maintained safely and effectively on Eliquis. Dr. Marc Gerdisch, Fransican Health discusses this study here
Could be a game changer, no more monitoring, special diet considerations, etc. I am 62 and will need surgery in the next 6 months, including aorta fix; I'm seriously considering the On X given lower INR requirements, etc. Don't like the idea of a second surgery when I'm in my early-mid 70's, though TAVR advancements might mean that's not as big a deal.
 

tom in MO

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There is a study underway to determine whether the On-X aortic valve can be maintained safely and effectively on Eliquis. Dr. Marc Gerdisch, Fransican Health discusses this study here
Could be a game changer, no more monitoring, special diet considerations, etc. I am 62 and will need surgery in the next 6 months, including aorta fix; I'm seriously considering the On X given lower INR requirements, etc. Don't like the idea of a second surgery when I'm in my early-mid 70's, though TAVR advancements might mean that's not as big a deal.
Per "special diet considerations", that's old fashioned thinking. Modern medicine no longer "diets the dose" but instead "doses the diet." All you need to do when on warfarin is eat a balanced diet and test regularly.
 

Superman

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I always get a chuckle out of all the dietary alarmist talk. One, because it’s false. Two, because even if it were true, we’d still have it easy compared to diabetics, allergy sufferers (leafy greens won’t kill us where we sit), and those with gluten intolerance. If all I had to do was avoid spinach to avoid repeat open heart surgery, sign me up all day long and twice on Sunday!
 

dick0236

Eat the elephant one bite at a time
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Per "special diet considerations", that's old fashioned thinking. Modern medicine no longer "diets the dose" but instead "doses the diet." All you need to do when on warfarin is eat a balanced diet and test regularly.
By cracky, I think they've finally got it🤪.
 

pellicle

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Per "special diet considerations", that's old fashioned thinking. Modern medicine no longer "diets the dose" but instead "doses the diet.
even funnier is that now we are understanding that by having a good solid vitamin K intake you can smooth out the ripples in INR


Conclusions
Increasing VK intake ≥150 µd/day through diet strategies improves anticoagulation stability of warfarin treated patients with a history of anticoagulation instability.

I dunno who thought this bullshlt up about not taking greens because you're on warfarin, but I'm willing to bet it was one of those dieticians ... (who've been the subject of scorn and derision in biochemistry labs since I can remember)

Old Australian Joke:

Mummie Mummie, I hate Granmas guts ...​
Well love, push them aside and eat all your greens instead​
 

Chuck C

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"even funnier is that now we are understanding that by having a good solid vitamin K intake you can smooth out the ripples in INR"

Excellent!

" Increasing VK intake ≥150 µd/day through diet strategies improves anticoagulation stability of warfarin treated patients with a history of anticoagulation instability. "

That's about 7 avocados per day! No problem! Pass the guacamole! 😀
 

pellicle

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Unicusp

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Conclusions
Increasing VK intake ≥150 µd/day through diet strategies improves anticoagulation stability of warfarin treated patients with a history of anticoagulation instability.

[/QUOTE]

Interesting. So, would it be advisable to go back to taking my normal adult multi-vitamin which contains only 30 mcg per tablet?
Might help to reduce my INR which is refusing to go down. What effect might that have?
I was on 3mg/day and now reducing to 2.5mg/day as my latest INR was 3.8
I'm also having a small spinach salad almost every day. Thanks!
 

Chuck C

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mate, you'll never save for the deposit on that house if you keep squandering your money on smashed Avo


;-D
"mate, you'll never save for the deposit on that house if you keep squandering your money on smashed Avo" 🤣
For many years I was an avocado farmer, so I had it coming out of my ears.

That guy makes good sense. I've been telling young people for years to stop spending so much on eating out, knock off the designer coffee and stay away from car loans- only buy a car if you can buy it outright, if you want to save enough to buy a home.
 

pellicle

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That guy makes good sense. I've been telling young people for years to stop spending so much on eating out, knock off the designer coffee and stay away from car loans- only buy a car if you can buy it outright, if you want to save enough to buy a home.
yep
in 2012 I told a chick I worked with (mid 20's) who asked me what should we do to save a deposit for a house? I said almost exactly what you you said to her and added (because this is available here in Australia) save everything you can into gold held at (government owned) Perth Mint. Now I cautioned her that it may not go up much but considering banks offer no interest on savings accounts you can't really go wrong.

I suggested that (looking at the numbers they presented) she and him could easily save $1000 a month.

Since then she bought a new car on finance through the dealer, (because her old one was old but still functional), goes out to the pub with her girl friends (blowing about $100 each night she does that) and is always buying stuff (iPhones what not) and has a steep credit card debit (her and her partner are both on good money)



still hasn't got any savings.
Median house price where she's looking to buy (where they're renting now) is AU$300k ... I make it that they'd have AU$90K now if they'd followed my advice
 

newarrior

I have mild moderate Aortic Stenosis live Bangkok
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I'll try to keep this brief. I was diagnosed with BAV & ascending aorta aneurism at age 50. Monitored the aorta for 2 years and had replaced by dacron graft at 52 at the Cleveland Clinic. Surgeon inspected the aortic valve and confirmed it to be a unicuspid that was healthy and functioning so he left it alone. Here I am 7.5 years later with severe stenosis and need replacement soon. I'm very healthy, active and asymptomatic. Heck, I walked over 12.5k steps at the Cleveland Clinic the other day walking between the many testing area's. I've pretty much decided that I only want to do this one more time. This second time is difficult enough. I can't see installing a tissue valve with an expiration date of anywhere between 1 and 20 years. Yes, the thought of Coumadin sucks, but I feel it safer than more invasive surgeries down the road. Yes, there is TAVR but that has many potential risks as well.
So, for me it appears to boil down to either the St. Jude Regent or On-X valves. Has anyone directly compared these two valves? They are both made from the same pyrolitic carbon and are very similar in design. But, my surgeon appeared to favor the SJ as it appears a larger SJ can be installed in the same area as a On-X, and he mentioned the On-X is "Bulky" and I guess requires a larger annulus for proper installation. Which valve has better hemodynamics? They both appear to be robust enough and tested to last a "lifetime". Any thoughts/comments/experiences appreciated. I apologize if I am re-visiting an old topic. Thanks everyone! By the way, this is a great site.
Amazing post--thank you !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
 

newarrior

I have mild moderate Aortic Stenosis live Bangkok
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On-X. Mainly for the promise of no ticking quietness and lower Coumadin/warfarin needed. This is confirmed vs other mechanical valves ? Less/no noise and less thinner needed ? Seems like everyone would go with On-X then ?
 

Chuck C

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On-X. Mainly for the promise of no ticking quietness and lower Coumadin/warfarin needed
It would be a good idea to read some of the threads on this topic. Most on this board seem unconvinced about the study which suggested that people could have a lower INR on the ON-X. My surgeon at UCLA indicated that he is skeptical and completely unconvinced about the lower INR claim, believing that the data does not support this. He also indicated that all of his colleagues feel the same way.
I believe you will find some very unfortunate stories on this forum from people who tried the lower INR with On-X and ran into trouble.
 

newarrior

I have mild moderate Aortic Stenosis live Bangkok
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As others have said On-X appears to have a lot of of marketing but little scientific studies to back up some of it's claims. If I am wrong please accept my apologies in advance. My knowledge of INR and warfarin is weak at best and I need to get up to speed ASAP..I know nothing about INR #'s or what they mean or how to stay in INR range or INR differences between valves. I just love the idea of less ticking as I already have tinnitus from hearing loss.
 

Superman

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It would be a good idea to read some of the threads on this topic. Most on this board seem unconvinced about the study which suggested that people could have a lower INR on the ON-X. My surgeon at UCLA indicated that he is skeptical and completely unconvinced about the lower INR claim, believing that the data does not support this. He also indicated that all of his colleagues feel the same way.
I believe you will find some very unfortunate stories on this forum from people who tried the lower INR with On-X and ran into trouble.
Many view it as a marketing decision designed to capitalize on the fear that warfarin = bad. I know I wouldn’t try to manage a 1.5 - 2.0 INR. A 0.5 window is tight to fit in and I’m far more afraid of potentially having a clot and a stroke than I am of cutting myself shaving.

Whether or not it’s quieter? Possible. I think this is very individual. Some of us just have echo chambers for chest cavities. Steel tends to reverberate. Get it? 😁

All that said, I wouldn’t lose any sleep if I had an On-X valve. I’m sure it’s well engineered and would last a life time (but of course it would! 👍). I just wouldn’t manage a low INR.
 

Chuck C

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I know I wouldn’t try to manage a 1.5 - 2.0 INR. A 0.5 window is tight to fit in and I’m far more afraid of potentially having a clot and a stroke than I am of cutting myself shaving.
I totally agree.
I wouldn’t lose any sleep if I had an On-X valve. I’m sure it’s well engineered and would last a life time
I agree. My surgeon favors the St. Jude, but it seems that many are very pleased with their On-X.
 

Chuck C

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As others have said On-X appears to have a lot of of marketing but little scientific studies to back up some of it's claims. If I am wrong please accept my apologies in advance. My knowledge of INR and warfarin is weak at best and I need to get up to speed ASAP..I know nothing about INR #'s or what they mean or how to stay in INR range or INR differences between valves. I just love the idea of less ticking as I already have tinnitus from hearing loss.
As Superman indicated, the On-X is probably a good valve, just don't trust the marketing that claims you can keep an INR of 1.5-2.0. That might be appealing, but many in the field are skeptical of their claim that this is ok, as well as the anecdotal evidence from this forum regarding those who have kept INR in this range with On-X.
As to whether it is quieter, I can't speak to that. I hear my St. Jude. I can't hear it now, but sometimes I do. How much that bothers a person probably has more to do with how the individual is wired.

When my dad was in the military he and my mom were stationed on base next to the train tracks. Trains would come by and wake them up in the middle of the night. By about 2 weeks they had acclimated and no longer were woken up by the trains. He said that they got so used to the trains that on the rare occasion that there were no trains he would sometimes wake up, kind of like his bio clock was telling him something was off. On the other hand, there are some people that will move next to the train and never get used to them going by.

The only time mine bothers me a little is at night. I use a HEPA filter on high in my room to create white noise and can't hear the valve at all.
 
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