On-X and Brand Loyalty

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On-X and Brand Loyalty


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    15

ElectLive

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Jun 26, 2011
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Atlanta, GA
Is it just me or are On-X valve recipients overly exuberant about their manufacturer? Does it come with some sort of rewards program? Has the marketing team been stealthily infiltrating users’ passwords on this site for years? Is Cupid the head engineer? Stock options? Is the president of the company secretly posting comments here nonstop daily under multiple false identities?

Seriously, though. Sometimes it’s blatant, sometimes it’s subtle. But more often than not it seems, it’s not “you should consider mechanical” but instead “you should go mechanical, and there are these amazing On-X valves by the way…”

So you know, I am a tissue valver with zero stake in this issue. In fact, On-X was the available “fallback” based on a few scenarios my surgeon might have encountered once he opened me up. But I’ve just been casually browsing posts of all types the last year, and the theme just never seems to stop, kind of spreading like wildfire. I originally thought it might be limited to a selected few major perpetrators, but now I’m wondering if it’s infectious.

I don’t know if it’s different for tissue valvers, or what, but sometimes I can’t even remember what my valve is, and have to look at my wallet card more often than not. Now, on the other hand, though, if tissue vs mechanical is the issue at hand, I could voice opinions about that until the cows (so to speak) go home…

In all seriousness, I do actually have a point to this discussion: should you really choose a valve before a surgeon? Now I chose surgeon first, but didn’t really have time to do otherwise. I would like to hear other reactions, though, so how about a poll:

If you had to choose between your favorite surgeon and your favorite valve, and you could not have both, which would you choose? Assume you could still get your tissue or mechanical decision with your favorite surgeon, just not your favorite manufacturer / model #.

Of course, didn’t mean to step any toes with the jokes, just curious. And by all means, I hope the pro On-X forces will post responses too.

Back to my open, maybe it is just me. It’s not like there are any big banners with the On-X name on it flying over this website… Oh wait, whoops. Kidding of course, I know that’s an entirely different matter.

Thanks for your input!


PS Attention any On-X employees, I’ve got a great plan for you: if you have enough money to throw at college football and change the minds of the powers that be, imagine this: a playoff (finally!) culminated with a championship “On-X Heart Valve Bowl”. It’s a great idea, I know, go ahead, it’s yours to use…
 

ken taylor

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Aug 15, 2009
Messages
152
Location
Boquete Panama
If you did your home work you would know why we choose ONX, could some one pay you to play or experiment with your heart ? I chose the valve because It is the best option today. Ill just mention one NO PANUS growth, just that fact alone sold me. This was my 2nd ohs and I would like to avoid a third. The surgeon is just as important I choose Igor Gregoric at St. Lukes In Houston. If my child needed a Valve those would still be my choice. Im interested to know do you work for another valve company? If so Im sory if onx is hurting your sells. The cream always reises to the top. P. S. PROUD ONX OWNER FOR LIFE !
 

scott.eitman

VR.org Donator
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Jun 7, 2010
Messages
457
Location
Beachwood (Cleveland), OH
I believe the answer is simple. I believe that you will find that all of us are "high" on the valve we chose. It was an important decision and we made believing it was the best or we would not chosen it at the time we did.

I am still high on the Homograft valve that has been replaced. It was the best at the time for me and it gave me 12 great years.

Scott
P. S. PROUD ONX OWNER FOR LIFE !
 

AgilityDog

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Nov 5, 2007
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1,637
Location
North Texas
I was given a choice between tissue and mechanical for my mitral, not a manufacturer. Had I realized I had a choice in manufacturer (and that there is, in fact, a difference in the 2 valves), and had my surgery not been emergent, I would have chosen On-x for my mitral valve in 2006, as I believe it is a true advancement over the St. Jude's.

Having more luxury of time the second round, I chose the On-x for my aortic valve in 2010.

If either valve ever needs replaced, no doubt I'll choose whichever valve appears to me to have the greatest advancements with a good proven track record at that time.
 

ElectLive

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Jun 26, 2011
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Atlanta, GA
Ok, so it only took one reply to illustrate my point. So I work for another valve company, huh? Wow, guess maybe I should have seen that coming. Sorry to say I am self-employed. Since you’re curious, yes sales are in fact down, but no, not in the valve market.

Hmm… Did I question the On-X valve itself? Did I say any other valve was better?

So you know, I did as much homework as I could prior to my surgery, to make sure I was comfortable with the backup plan, but certainly not an exhaustive side by side comparison, just wasn't enough time. I did do enough to convince me that On-X might in fact be the best, and at worst, was more than adequate for my second chance of life.

But let’s step back, my point was not at all about which valve is best. That’s all over the place, doesn’t need to creep in here. My point is: there seems to be an inordinate On-X undertow to even the most basic mechanical vs tissue discussions. I haven’t seen nearly as much “enthusiasm” from patients who went mechanical but with another manufacturer. I guess my only criticism is it felt like On-X is being pushed (often irrelevant to the thread at hand) a little too much. Or who knows, maybe everyone else (patients with other manfuacturers) isn't pushing enough.

Being “high” on a valve is a great thing. I hope everyone is. I certainly am, even if I can’t remember the name of it. Sorry if my attention grabbing lead-in distracted from the main issue – valve versus surgeon.
 

ken taylor

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Aug 15, 2009
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Boquete Panama
Well now , Quiet obivous to me that the best valve in the world would be of no use in the hands of a poor surgeon, and the worst or lets say a chinese 50 cent valve just might not matter in the hands of a great surgeon. To me your poll is silly a great driver without a great race car cant win the race!!!!!!!!
 

ElectLive

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Jun 26, 2011
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Well, I wondered out loud if patients with other manufacturers weren't pushing enough in comparison. Guess now we'll find out...what's everyone else think about their 50 cent valves?
 

ken taylor

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Aug 15, 2009
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Boquete Panama
you are missing the point again it takes a good surgeon and a good valve, there are many good valves, you first ask why everyone was high on onx, we told you. Why does a person that does not know what valve they have in there heart even care??
 

ElectLive

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Agreed, good surgeons and good valves. We all would start with those minimium guidelines. But, one thing that really surprised me about the whole valve replacement thing (more so after the fact) is how often choosing a surgeon means actually choosing a valve, oftentimes only one model a given surgeon will do for each type (mechanical and tissue).

You seem to be saying that if your preferred surgeon hadn’t offered On-X, you would have found just as good a surgeon who did. I certainly respect that, it’s basically what I’m asking. It may not always be so easy, though. Some surgeries are rushed. Some people are in places where there aren’t many options. Or, maybe most importantly, some people trust that their preferred surgeon offers a given valve because in that medical expert’s opinion, it is the best option.

I’m still on the fence for next time, and am curious where others stand. Obviously I care because I need another valve someday. I get time to plan ahead this time, thank goodness.

Now, as a side discussion, does anyone really know how these decisions are made at hospitals? Surgeons in consensus? Individual surgeons? Research money? A little bit of everything? Different everywhere?
 

ken taylor

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Boquete Panama
I was considering two surgeons at St. Lukes in houston . Boath great in there field. I went with Dr. Gregoric because I found out he has a lot of experance with ONX the other Dr. uses another valve. I found out in many cases it would be easier for a surgeon to switch wifes than valves there use to doing.
 

Julian

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Jun 21, 2011
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581
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Southern California
I truly think a good surgeon can insert any valve if he/she is good. I understand some surgeons feel better with installing things they are familiar with, wouldn't you? Point is, Beethoven may have had a favorite piano but if he arrived on stage and was presented with a piano he wasn't familiar with he would still rock the house and you and I wouldn't notice the difference. To me the choice is almost equally important, if the surgeon makes a mistake you have to live with it, if a valve is installed that you don't feel comfortable with your stuck with it. I personally want an On-X valve and a good surgeon should be able to install an On-X even if he favors St. Jude.
 

ALCapshaw2

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Mar 20, 2003
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North Alabama
Finally, the right questions are being asked.

Some surgeons offer only One Mechanical and One Tissue Valve.

Some Hospitals (CC, Mayo) put their Valve Business up for Competitive Bid and pick 2 of each type.

So Yes, Choosing a Surgeon IS often tantamount to choosing the type of Valve you will receive.
 

ElectLive

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I found out in many cases it would be easier for a surgeon to switch wifes than valves there use to doing.
Interesting perspective. So do you think it's more of an "installation" issue, and less so of belief in the long term outcome of the valve?
 

ElectLive

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I understand some surgeons feel better with installing things they are familiar with, wouldn't you? ... I personally want an On-X valve and a good surgeon should be able to install an On-X even if he favors St. Jude.
I guess comfort zones exist in all professions, even those where lives are on the line. And maybe it's even more critical for surgeons, any deviation, any surprise could have dramatic consequences. That said, your surgeon goal still seems more than reasonable. It's not like there are hundreds of valves out there to master.
 

ElectLive

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Some Hospitals (CC, Mayo) put their Valve Business up for Competitive Bid and pick 2 of each type.
Seriously? Wow. Do you know if all the surgeons at those hospitals at least offer both types, or does it still come down to individual surgeons?
 

Jeff Edmonton

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Dec 26, 2010
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253
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Canada
Life is easy, make choices and don't look back. We are very fortunate that we live in a day and age where we actually have these medical choices. Or, 100 years from now will they look at the way this surgery is performed today and say how primitive.
Bdryer (Bruce) was the 1st to get an ON-X valve in Calgary, AB, CAN., he almost persuaded me in my choice. You are correct, there is persuasion on this site, there is also wisdom, caring, love and support. Individually we make our choices and are the drivers of our newly transformed bodies.
No one ever said life would be easy, so I grew my own Rose Garden.
 

normofthenorth

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Nov 1, 2010
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Toronto, ON, Canada
I started with a referral (from my excellent Cardiologist) to a world-class surgeon at a world-class cardiac center. He recommended a tissue valve, a Hancock II pig valve. Based on some reading here (some of repeated recently by people who should know better ;-) ), I was under the erroneous impression that cow valves routinely lasted longer than pig valves. (Based on the latest study, the Hancock II has been outlasting all other valves with 15-plus-year records, and it has a 20-plus-year record.)

When I challenged him on the durability issue, he gave me a copy of that 2010 study (which was written by his colleagues in Toronto, including Tirone David), which completely convinced me and reassured me.

OTOH, when I got concerned that his fave pig valve had worse hemodynamics than the leading cow valve, and I challenged him on that, his answer did NOT cover the ground for me. In fact, he himself is a co-author of a study showing that the CEP cow valve DOES have superior hemodynamics to those of the Hancock II! So I was faced with a more complex choice than "surgeon vs. valve", it was more like "demonstrated durability" vs. "demonstrated hemodynamics" vs. "great surgeon". (In fairness, Dr. Feindel and his colleagues DO sometimes install some CEP "cow" valves, but they prefer the Hancock II "pig" valve.)

I went with the great surgeon and the "demonstrated durability", and I'm pretty convinced that new-valve hemodynamics is a meaningless variable, except for people with unusually small AVs compared to their body size (aka "donor-valve mismatch").

On the mech-valve side, it's pretty clear that On-X has developed a very good valve, and have also been very energetic and aggressive in promoting it -- including helping to fund this forum, for which I'm very grateful! They were also gracious enough to stop using a banner her that many of us thought went TOO far, into the range of tasteless and misleading, for which I'm also grateful.

According to On-X and their supporters (including most of their end-use customers), the advantages of their valve are clear and obvious:
  • A superior carbon construction material, which they claim resists thromboembolic effects and attachments;
  • A wide-opening mechanism, which is claimed to decrease turbulence and damage to blood cells;
  • Some evidence, from a group of badly-anticoagulated patients, that it might work OK with lower -- or maybe conceivably NO -- levels of ACT;
  • Permission from the US government to pursue (and continue) a trial with one or two less intense ACT regimes (NOT including Aspirin only, though that claim is often repeated, maybe even once by me!);
  • The On-X valve expressly incorporates features designed to discourage the growth of pannus, which is apparently one of the leading causes of re-ops for mech-valve recipients -- and it seems to be the only mech valve that does!
  • It's too new to have directly demonstrated durability, but I think most of us accept the claims based on accelerated life-cycle tests, that show that virtually all current mechanical valves should physically last longer than a full human lifetime -- i.e., "forever".
That's obviously a lot to like!:D

I was part of the On-X Glee Club myself, until I dug up some competitive information from ATS (now part of Medtronics), the manufacturer of the mechanical valve that is virtually always found to be the QUIETEST mech valve in comparative studies. Their web-site has a couple of separate sections that just kind of sit there, quietly buried in their own web-site, undermining a number of On-X's impressive claims.

For example, one page deals with what ATS/Medtronics calls On-X's "magic carbon", and its associated claims that it's less thrombogenic, and therefore should be fine with lower levels of ACT/INR/Warfarin/Coumadin. The page reports the results of several studies showing the level of thromboembolic events (clots) in On-X and ATS patients on NORMAL levels of ACT/INR. Logically, if the On-X is more resistant to clot-formation, that advantage should appear at ALL levels of ACT/INR, not just at extra-low levels. But it doesn't. As I recall the data, the On-X patient's rate of clots seemed to be HIGHER than the ATS patients', not lower. The page also shows some photographs of ATS and On-X leaflets after they were exposed to possible clotting, and the photos SEEM to show that there's just as much clot-like stuff sticking to the "magic carbon" as to the ATS carbon (though they're pretty small photos).

In addition, when our BAV colleague 'pem' "drilled down" into the data, including direct communication with reps from On-X and Medtronics, he turned up enough evidence to convince him to choose an ATS/Medtronics Open Pivot mech valve instead of an On-X valve for his own heart. (His surgery is coming up very soon, so wish him well, since none of these statistics come with a guarantee!)

Most of that discussion is here. The charts showing the actual well-being of On-X and ATS patients at 1, 2, & 3 years post-AVR (as submitted to the US FDA using their reporting protocols) are especially striking, IMHO. Pannus schmannus, it seems that the ATS patients were a bit LESS healthy/fit/well off going INTO the AVR surgery, but were very significantly MORE healthy/fit/well off afterwards! (Details, details!)

Based on all that information, I think the best mech valve available now is probably the ATS/Medtronics, and I've joined their "Glee Club".
 

New Guy

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Jul 6, 2010
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140
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Chicagoland
I just hope the promises on-x has made are true. If so I will continue to disregard the fact that my on-x is too loud and be glad I forced my surgeon to use it for me against the hospitals policy (Mayo Clinic. They use the St Jude Masters series and the newer St Judes model. My surgeon is head of the cardiac dept and agreed to try the on-x for me)

I didn't have a choice of surgeons at Mayo, but I chose the hospital on reputation only and I believe all the surgeons there are great.

By the way, nobody ever told me this or any other mechanical valve would be queiter or better on any way than any other. In fact my Docs claimed they were all the same in general. I didn't believe that then or now and I dont believe they do either.
 

ElectLive

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So I was faced with a more complex choice than "surgeon vs. valve", it was more like "demonstrated durability" vs. "demonstrated hemodynamics" vs. "great surgeon".
It sounds like valve patients never get any breaks, huh? You dig deeper to clarify decisions, but the opposite can happen too.

Thanks for your post. I initially thought this could be a fairly broad discussion, but it seems that details can certainly add perspective to the issue too.
 

ken taylor

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Aug 15, 2009
Messages
152
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Boquete Panama
Like I said, I to have been in sells all my life, I know you sell the sizzle not the steak. Most everything about all valves ,for me were taken with a grain of salt. Except one thing ONX was built to retard panus growth and they have never had one valve reported to have this proublem. For me that was enough to get my business
 
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