Hello - just caught up on all the new posts. I was off digesting the feedback (and procrastinating the decision). I've been to the ATS/Medtronic site to learn more about the bileaflet valve that NormOfTheMonth pointed me to. There is certainly a lot to like about both the On-X and ATS valves. However, with sincere due respect to the companies that devote their resources to developing better valve options for us, I find it difficult in my search to sort the hype from the help. For example, on the ATS site, I found a section that directly addresses the On-X claims. In this section, I found microscopic imaging (
http://www.atsmedical.com/Physicians.aspx?id=2470) of blood adhering to the very substance that On-X purports to have low-adhesion properties, both in the presence of aspirin and aspirin with plavix. At first I was alarmed. But after my emotional response subsided, I realized that it was impossible for me to interpret those photos or the implication that they contradicted the On-X claims. The caption on the site: "Platelets still adhere and aggregate, no magic!" It occurred to me that stagnant blood on any surface in the presence of oxygen might coagulate and simply bind to the surface in different patterns depending on the adhesion characteristics. Whether that's true or not, those photos, unless taken in an environment that is hemodynamically similar to that of the aortic valve, do not seem inherently meaningful - do they? So, perhaps I lack the medical knowledge to see the relevance of those photos - are they indeed more hype than help? On the other hand, it is only reasonable that Carbomedics would report their own findings in only the most favorable light. So, while I believe both companies promulgate facets of the truth, I find it exceedingly difficult to reconcile the apparent differences between them. If anyone can shed light on this, I'd be grateful.
There's also a practical matter. Let's say for argument sake that the ATS valve is even better suited to low ACT or even non-coumadin ACT than the On-X. What would compel someone to opt for the ATS given that the FDA trials for On-X may result in a non-coumadin option, which does not seem to exist on the near horizon for the ATS? With ATS, one would have to go against current FDA-based recommendations for ACT. I suppose one could argue that the value proposition with ATS is that even on standard ACT (INR at 2.5), one could expect very low rates of thromboembolic events relative to other valves, and also fewer such events when ACT had to be temporarily stopped for whatever reason. Someone please check my reasoning here - I'm sure I'm missing something (which is one reason why this forum is so great).
On a more personal note, I continue to be leaning toward mechanical valves because ACT seems better suited to my psychological makeup than the prospect of resurgeries (understanding that each can happen with either valve type). My local surgeon seems to be experienced with ATS valves, but the other surgeon (out-of-state) that I've met with is considered an expert with On-X. I guess the good news is that I have two good options, but it certainly doesn't make the decision any easier. I'm wondering how big of a factor should it be to have the surgery performed close to home - was this a factor in your decision and in retrospect, would you do anything differently?
Another question: My last echo was in November - I don't remember the numbers but I was told my stenosis was moderate and my insufficiency was severe. I was told that surgery was recommended to occur in the next six months (it has now been 5 months). I recently had a follow-up echo that was unchanged since November, no enlargement of the heart, and still no symptoms. How long could I reasonably wait to have surgery? My cardiologist seemed to think that I should be fine as long as I have it by September, which seems to extend the time frame a bit. Just wondering if anyone had an opinion on this, possibly based on personal experience.
Thank you for all your previous insightful replies and for your patience with my posting and my questions.
