Choosing either the On-X or St. Jude Regent...opinions?

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Pat in NH

Pat in NH

VR.org Supporter
Supporting Member
Joined
Apr 4, 2010
Messages
47
Location
NH USA
Hi all,

It seems that my waiting stage is quickly coming to an end. I spoke to my surgeon Dr. Bolman at Brigham and Womens today and he let me know that my latest echo (4/23/10) was even worse than I thought it would be. My AVA is now down to .7 square centimeters. Just one month ago it was .84 sc.

I actually have a surgery date for Tuesday May 11. That's going to come fast!

So I'm reading reading reading. As much as I can about mechanical valves. The On-X is at the top of my list for several reasons, but the St. Jude Regent seems very comparable and has a much longer track record.

Does anyone have any words of wisdom about my choices? I would very much appreciate any input!
 
Pat in NH said:
Hi all,

It seems that my waiting stage is quickly coming to an end. I spoke to my surgeon Dr. Bolman at Brigham and Womens today and he let me know that my latest echo (4/23/10) was even worse than I thought it would be. My AVA is now down to .7 square centimeters. Just one month ago it was .84 sc.

I actually have a surgery date for Tuesday May 11. That's going to come fast!

So I'm reading reading reading. As much as I can about mechanical valves. The On-X is at the top of my list for several reasons, but the St. Jude Regent seems very comparable and has a much longer track record.

Does anyone have any words of wisdom about my choices? I would very much appreciate any input!
Click to expand...

Should I need another Valve, On-X would be my First Choice with the St. Jude MASTER's Series Valve as a Plan B.

The St. Jude Master's Series has a track record going back 30 years. It is my impression that the St. Jude REGENT is St. Jude's answer to the On-X valve with 'some' similar features but not all. It would be interesting to know how many Regent Valves have been produced.

'AL C'
 
Having the option I chose the On-X. I would make sure you had a surgeon who has done a number of them though.
 
Surgeon and I agreed on On-X; however, I got a St. Jude Regent because the On-X wasn't fitting right. I don't know how common this is.
 
Thanks you for the replies so far.

Al, I will put the St. Jude Master's Series on my list of research. Just looking at the site pics quickly I doubt I could tell any of them apart. Does anyone know of a website that compares current mechanical valve choices? That would be super helpful. I'd like to see something more in depth than the manufacturer "brochure" style sites.
 
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My surgeon was extremely confident with the history and his usage of the Regent valve. He is very forward thinking and has been doing percutaneous valve implantations for the past few years. I really couldn't digest tons of technical info from various valve research papers and journals, so I placed my confidence in him.
Going with any of the top valves will save your life anyway.
 
Choices

Choices

I've got a Regent and so far it's worked well. When I was in the choosing stage the On-X had a great deal of appeal. After much discussion with my surgeon, I opted to a Regent.

The major factor for me was that a healty chunk of my aorta needed to be replaced and the regent came with a factory attached conduit; the On-X didn't. I was concerned about getting off the heart lung machine as quickly as possible. The factory installed conduit on the Regent probably saved me a few minutes. I found out later that a decent surgeon can install a conduit on an On-X pretty quickly.

Both products have received really good reviews from members here. The On-X reportedly does less damage to blood cells than other valves.

-Philip
 
When I had my AVR almost 10 years ago, the On-X wasn't a choice; it was strictly St Jude or tissue. One of the things that helped my decision was that my surgeon had implanted several hundred St Jude valves. What ever your choice, make sure your surgeon is well-experienced with that particular valve.

Mark
 
I have an ATS Open Pivot AP360 in aortic position and it seems to be working phenomenally well! My ejection fraction was already up to 55% within 2 months of surgery and I had started out with stenosis in the critical range and EF of 25%, in other words was knocking on death's door before surgery. I now feel as if the clock has been turned back 20 years. I believe it is similar in construction to ON-X. Similar to the ON-X this valve has several years of follow up study of low dose anticoagulation (INR range 1.5 - 2.0) with excellent results. There is a link to that somewhere on the manufacturer's site. My surgeon told me that the valve would outlast me, that its expected lifespan is 100 years and I am close to 60 now, chronologically anyway.

The bottom line, IMO, is for your surgeon to use whichever valve he or she is most familiar with. Let's see if this link works, http://www.atsmedical.com/Products.aspx?id=836
 
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Pat: I just had an e-mail exchange with my B&W surgeon, Dr. Shekar. I had asked if he had a recommendation or a preference for a particular mechanical valve, and he replied that he thought the On-X would be best for me. I don't yet know his reasoning, but I thought I'd pass along this information anyway. My surgery is not until late July.

Best of luck.

Dan
 
Thanks Jeanie and Dan for the info!

I met with my surgeon yesterday and he was fine with my choice, so it will be the On-X. He didn't seem to have a strong opinion about any of the top mechanical choices saying that he thought they all perform about the same.

Best of luck to you Dan! I'll have my surgery On Tues 5/11. :eek:
 
Jeanie said:
I have an ATS Open Pivot AP360 in aortic position and it seems to be working phenomenally well! My ejection fraction was already up to 55% within 2 months of surgery and I had started out with stenosis in the critical range and EF of 25%, in other words was knocking on death's door before surgery. I now feel as if the clock has been turned back 20 years. I believe it is similar in construction to ON-X. Similar to the ON-X this valve has several years of follow up study of low dose anticoagulation (INR range 1.5 - 2.0) with excellent results. There is a link to that somewhere on the manufacturery's site. My surgeon told me that the valve would outlast me, that its expected lifespan is 100 years and I am close to 60 now, chronologically anyway.

The bottom line, IMO, is for your surgeon to use whichever valve he or she is most familiar with. Let's see if this link works, http://www.atsmedical.com/Products.aspx?id=836
Click to expand...

Actually, the construction of the ATS (and Carbomedics) Valves (1980's vintage?) have more in common with the Earlier St. Jude Valves than the On-X valves which were designed in the mid-1990's to reduce some of the known 'issues' with earlier mechanical valves. Jack Bokros, Ph.D. was involved in the design of ALL the major Mechanical Valves and is credited with the development of the Pyrolytic Carbon that is used in the leaflets of the Bi-Leaflet Mechanical Valves made in the USA (and elsewhere?). If you do a Search on keyword "Bokros" you will find links to posts detailing his involvement.

Can you tell me where I can find information on the Low Dose AntiCoagulation Studies using ATS Valves?
I've not heard about those before. Do you know who conducted those studies? or where they were published?
Out of curiosity, what INR Target Range was recommended to you.

From what I've read, All Mechanical Valves have been designed (and tested) to operate longer than anyone would expect to live (i.e. several lifetimes). The primary reasons for replacement of Mechanical Valves have to do with Patient Tissue Issues (Pannus Tissue Growth, Stitching Failures in patients with Connective Tissue Disorders, etc.) or Bleeding Risk Issues (typically brain bleeds in susceptible patients... which tend to be rare).

'AL C'
 
Al, I will 'rummage around' in the ATSmedical website and see if I can find that study. I guess I should have clarified what I meant by the 'similar to' comment; I was referring to it being carbon. With regard to my INR range, I am not sure but I think it was originally 2.5 - 3.0 and now is 2.0 - 2.5, but the longer time passes since my early February A-Fib episode, they are being happier with my number being closer to 2.0 than 2.5. As to whether it ever will be dropped down any lower, I have no clue, sorry. I also take an 81mg ASA (baby aspirin, enteric coated, in morning; warfarin in evening.) In the process of trying to find more on INR range, I discovered I had misremembered something; the range shown in their chart is 1.5 - 2.5, sorry. They are pretty much cutting edge at Univ of Nebraska Med Center where I had my surgery; it is home of the Lied Transplant Center among other claims to fame. That leads me to believe this valve is also likely to be considered cutting edge of technology. Here is the CV of my surgeon, FYI, whom I believe to be absolutely briliant. I found out recently the damage to my heart was more severe than I had realized and in reading the surgery summary report, discovered just how very skilled he is considering what he was faced with fixing:
http://www.unmc.edu/ctsurgery/dorheim.htm
more about UNMC: http://www.unmc.edu/ctsurgery/cardiacsurgery.htm

Here is more info on the valve, including links to the low dose anticoag -
http://www.atsmedical.com/Products.aspx?id=820
http://www.atsmedical.com/uploadedFiles/Public_Site/Products/Mechanical_Valves/st_broc_AP360R1.pdf
http://www.atsmedical.com/Search.aspx?searchtext=low+dose+anticoagulation
http://www.atsmedical.com/Physicians.aspx?id=2666 wrt shear stress reduction reduces thrombogenesis
 
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I wish I could remember the reasons, but when I asked my surgeon about the exact same options (On-x vs. St. Judes), he convinced me to go with the St. Judes Regent - and so far so good. I do hear the click others have mentioned, but am pretty much used to now (6 days after surgery). While he was very familiar with both, he felt a little more comfortable with the St. Judes Regent. I think one of the reasons had to do with the track record, but I think there were other reason(s) too, he just said it all too fast I didn't absorb it all (was also asking about minimally invasive vs. regular incision and some other things). Further, he told me (don't know if true, so don't take as gospel, but maybe...) that like the On-X, the Regent requires less anti-coags than the other mechanical valves. My INR range is 1.8 - 2.x, which is lower than 'normal', so I think that bears that out. I can't remember what "x" is, going in Thurs to get tested for first time since leaving hospital and will find out, but the lower end is definitely 1.8 as I hadn't reached that when leaving the hospital. And I think normally the lower-end is 2.0 or 2.5. He also told me (again, take for what it's worth, no more) that the Regent has as much chance as the On-X of not needing anti-coags someday, it's just not publicized as much. That would be 3-5 years down the road, if the research pans out. But I was pleasantly surprised to hear I had some hope of that with the St. Judes - as I'd read that chance was only there with the On-X before. Lastly, and again, I don't know how true this is, but a nurse told me just before I left the hospital 2 days ago that there's a Coumadin replacement being tested (and proving out very well) which will be much easier on us than Coumadin (will require less INR testing, will not require as much consistency in diet, etc.). So let's keep our fingers crossed that pans out!
 
Pat in NH said:
Thanks Jeanie and Dan for the info!

I met with my surgeon yesterday and he was fine with my choice, so it will be the On-X. He didn't seem to have a strong opinion about any of the top mechanical choices saying that he thought they all perform about the same.
Best of luck to you Dan! I'll have my surgery On Tues 5/11. :eek:
Click to expand...

There's an honest guy!
 
ARGreenMN said:
Pat, just wondering what your recommended INR range is with your new On-X. Mine (with St. Jude Regent) is 1.8-2.2. And how is it going overall with you?
Click to expand...

Hi Andy,
My surgeon says he wan'ts my INR from 1.5-2.5. Yesterday it was 1.6, so it looks like their shooting for the low end of the scale. I kinda thought they'd try more for the middle, but I know the first several weeks can be tough to nail the numbers.

I'm doing well! My surgery was on 5/20 then I had 5 full days in the hospital. Got home, felt good , did too much felt real bad, then learned a hard lesson, ha ha! Now I'm taking it slow and easy and feeling leaps and bounds better everyday. Just amazes me!

Thanks for asking :)

-Pat
 
Pat,

Glad your surgery went well. Your job right now is too take it slow and easy.
You are still in recovery mode. Get plenty of rest and enjoy the nice weather.
 
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