OnX vs St Judes, ding, ding

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Hot Rod Harry

Well-known member
Joined
Aug 26, 2006
Messages
214
Location
Michigan
I'm trying to decide on which valve to go with. I've read alot, and not really swayed one way or the next. Ok, maybe a little leaned towards the St Judes, because my cardiologist touts it's many, many years in service, with a few upgrades here & there, to stay current.

I see that the OnX has a coating of some sorts, that is supposed to reduce clotting, and such. The question in reply, is, are there St Jude valves that are clotting, with proper medication? To tout this as a benefit, makes me wonder if this was a problem with the other valves out on the market.

I'm about 7 weeks from getting this done. I've already had OHS 3 years ago to "repair" the Mitral valve. Only, that "repair" did not last long.

So, if it makes any difference, this mechanical valve will be in the mitral position.
 
I must be careful ..................

I must be careful ..................

how I word this response.

One version of a St. Jude valve was coated in a substance to reduce endocarditis. Something to repel infection. If the On-X is coated it wouldn't hurt to inquire with what and why. From what I've read here the On-X has been on the market for years unlike the coating on the now withdrawn St. Judes. I think the hope is the On-X will require only aspirin as an anti-coagulent and not warfarin. St. Jude may have made improvements but that coating wasn't one of them unfortunately.
 
St. Jude is the gold standard, but in all honesty, I'd go with the On-X given a choice. My surgeon wanted to use it on me, but since my aorta had already been partially replaced, he needed a valve with the graft sleeve attached and St. Jude was the answer at that time.
 
how I word this response.

One version of a St. Jude valve was coated in a substance to reduce endocarditis. Something to repel infection. If the On-X is coated it wouldn't hurt to inquire with what and why. From what I've read here the On-X has been on the market for years unlike the coating on the now withdrawn St. Judes. I think the hope is the On-X will require only aspirin as an anti-coagulent and not warfarin. St. Jude may have made improvements but that coating wasn't one of them unfortunately.

Your speaking of the Silzone valves. Those are long ago pulled from the market. I was doing some research on Seths thread and nearly all of the St. Jude valve failures with current models were the result of the surgeon not doing something right.
 
I'm trying to decide on which valve to go with. I've read alot, and not really swayed one way or the next. .............

So, if it makes any difference, this mechanical valve will be in the mitral position.

Sorry that your repair did not last you long.

Just sharing a thought and not persuading you towards any valve.

I have St. Jude in both valves as you can see in my signature. The one in the Mitral valve is one of the newest version of St. Jude and according to my surgeon it is designed to allow some blood to leak to wash any blood precipitation that may cause a clot!!

So, you may check with your cardio or surgeon as not all cardios are uptodate with the valves technology!
 
I am going tissue but researched both. The advantage to On-X is a gentler close of the valves which is assumed to do less damage to the blood. Yes it is coated with ? can not remember but is suppose to give is a surface that does not let stuff stick. There are trials going on now to see if it will work with less cumidin or even with just asprin. The jury is still out on this but it is a posibility. Like Ross if I were going mech. That is the one I woild choose. owever, you must make the choice you decide you want.
 
Sorry that your repair did not last you long.

Just sharing a thought and not persuading you towards any valve.

I have St. Jude in both valves as you can see in my signature. The one in the Mitral valve is one of the newest version of St. Jude and according to my surgeon it is designed to allow some blood to leak to wash any blood precipitation that may cause a clot!!

So, you may check with your cardio or surgeon as not all cardios are uptodate with the valves technology!

Thank you. Yes, I know the cardios are not up to date with the valve tech. It's great that we have the net to provide us with valuable info.

I expect to meet with a surgeon in the next few weeks, in Cleveland, for exam, and to go over options.
 
Valve Choice

Valve Choice

Based upon some of the postings I've seen here, it sounds like the Cleveland Clinic folks prefer tissue over mechanical.

Both valves you asked about are good products with good reviews from members here. My preference was OnX, but opted for a St. Jude because, like Ross, the factory attached conduit was only available on the St. Jude. The conduit saved me a little time on the heart-lung machine. Later, I foundout that a great surgeon can attach a conduit to the OnX sewing cuff in just a few minutes.

-Philip
 
I'm trying to decide on which valve to go with. I've read alot, and not really swayed one way or the next. Ok, maybe a little leaned towards the St Judes, because my cardiologist touts it's many, many years in service, with a few upgrades here & there, to stay current.

I see that the OnX has a coating of some sorts, that is supposed to reduce clotting, and such. The question in reply, is, are there St Jude valves that are clotting, with proper medication? To tout this as a benefit, makes me wonder if this was a problem with the other valves out on the market.

I'm about 7 weeks from getting this done. I've already had OHS 3 years ago to "repair" the Mitral valve. Only, that "repair" did not last long.

So, if it makes any difference, this mechanical valve will be in the mitral position.

The On-X valve does not have a "coating of some sorts", it is made of the Latest and Greatest Version of Pyrolytic Carbon which is Harder, Smoother, and Stronger (and Patented as On-X Pyrolytic Carbon) than the earlier versions (which were ALL created by Jack Bokros, Ph.D. and his group). Do a Search on VR.com for keyword "Bokros" to find my writeups on his background.

Here is a copy of a post I wrote on Dec. 30, 2008 comparing On-X and St. Jude Mechanical Valves.

QUOTE:

The St. Jude Master's Series Valves have been around for 30 years and counting so they are 'Good Valves'. (I have one). I just happen to think that the On-X is a 'Better Valve' in several areas:

Reduced Risk of Clot Formation because of:
1- Reduced Turbulence due to full 90 degree opening
(vs. 75 to 85 degree openings for older valve designs)
2- Harder, Smoother (patented) evolution of the Pyrolytic Carbon material in the leaflets (Designed by Jack Bokros, Ph.D., who also designed the leaflets in St. Jude, ATS, and Carbomedics and holds several Patents)
3- Improved (smoother) Valve Pivots

Less Damage to Red Blood Cells (Hemolysis)
- equivalent to levels in Tissue Valves, about 1/2 the level in older mechanical valves.

ONLY Valve that has a built-in Barrier to Pannus Tissue Growth which is the Major Factor in Mechanical Valve Explantation (i.e. Removal and Replacement) - This is a Low (but NOT Zero) Risk condition that has been reported on VR.com for both Mechanical and Tissue Valves.

Anti-Coagulation with Coumadin / Warfarin gets around the Clotting Issue (for the most part) *as long as INR is In-Range*.

The BIG ISSUE and Difference is when it is necessary to go OFF Anti-Coagulation for Invasive Procedures.

OLDER Mechanical Valves are Known to cause Clot Formation after ?? days when going OFF Coumadin.

Experience with the On-X Valves in Africa with a substantial population of Non-Compliant recipients shows greatly reduced risk of Stroke compared with the older Mechanical Valve Designs in patients whose INR is NOT in
Range (ask On-X for a copy of the Study).

FYI, the On-X Valves were introduced to the World Market in 1996 (12 Years ago) and there are over 70,000 On-X Valves in use around the World (in 64 Countries).

Yes, It's the "New Kid on the Block", but it's no longer in 'childhood' (as many in the Medical Field seem to think).

It comes down to answering the Question:
Do you want the latest improvements in technology with a 12 year track record or,
Do you want a Valve that has been around for 30 years with good results?


BTW, the St. Jude REGENT Valve (for the Aortic Positon ONLY) was introduced in 1999(?), AFTER the On-X valve came onto market. It would be interesting to know how many have been implanted. There was a report on surgical experiences with this valve in a Medical Journal a few years ago. (I'll have to look up the reference).

MY preference would be On-X as First Choice
with the St. Jude Master's Series as Second Choice.

'AL Capshaw'

Disclaimer: I am NOT a Medical Professional, merely an interested Heart Valve Patient. The above is a summary of my 'understanding' and is my non-professional *opinion*.

END QUOTE
=======

The following is a comparison of Morbid Event Rates for Mechanical Valves which I copied from a Table that was included in an "Information Package" from On-X.

From www.ValveReplacement.com - Valve Selection Forum - January 2009 - Thread Title: "St Jude"

QUOTE

A few years ago, On-X sent me an 'Information Package' which included a pair of tables entitled "Morbid Event Rates Comparison" for both the Aortic and Mitral positions with footnotes indicating the source of the data for each company which included PMA (something about Safety and Effectiveness) Summaries (ATS and CMI) and FDA submissions.

The combined rates in (% per pt-year) for Thromboembolism, Thrombosis, and Hemorrhage for the

Aortic Position were

On-X = 2.14 % per pt-year
SJM = 3.90 St. Jude Medical
CMI = 2.96 Carbomedics
ATS = 4.04 ATS
MH = 2.50 Medtronic Hall (I believe that is a single leaflet valve)

Mitral Position

On-X = 1.86 % per pt-year
SJM = 3.34
CMI = 4.44
ATS = 5.07
MH = 4.30

I left off the breakdowns by categories because I'm not about to sit here and re-type all that data. Note that other factors such as Hemolysis (blood cell damage) and Pannus Tissue Growth are not included in the above statistics.

The complete charts are available to ANYONE who asks for them. Just call or e-mail On-X and they will send you whatever information you request. Contact information is on their website www.onxvalves.com or 888-339-8000.

They have recently published another set of Bar Graphs which also include several tissue valves (which I find a little hard to interpret - too much information in too little space... give me the numbers in a spread sheet format please).

'AL Capshaw'

END QUOTE
========
 
One of the reasons that I was told by my surgeon that he would not use the On-x is because he could put in a larger size valve with the St. Jude, allowing more blood flow because of how each of these sits in the aorta. I also had the aortic root replaced so this may have been a factor.
 
Your speaking of the Silzone valves. Those are long ago pulled from the market. I was doing some research on Seths thread and nearly all of the St. Jude valve failures with current models were the result of the surgeon not doing something right.

Hi Ross,
I'd like to read that myself. Can you post a link?
Sandra
 
Hi Ross,
I'd like to read that myself. Can you post a link?
Sandra

Do a GOOGLE Search for "Silzone" and you should find many links to reports on that Recalled St. Jude Valve. You might also want to do a Search on VR.com for "Silzone". Be sure to extend the timeframe to include "Any Date" (at the bottom of the extended Search window).

It is my understanding that several people died from complications with the St. Jude Silzone Valve including the wife of (former) VR.com member "Billy"? from Ireland.
 
From my research I agree with Al and Ross. I am going tissue. However, if I were to get a mechanical it would be On-X. If a surgeon talks it down it most likely means they have not used them. I would find a doctor who has put several in before. Akso while doing the research I learned that even if you need a aorta repair it can be sewed on pryor to the operation.
 
I have a Carbomedics MV and was wondering why that usually isn't discussed as an option? (correct me if I'm wrong on that observation) And in reading signatures, not as many people have them. At the time I don't think I felt I had choices, even though I was aware of different valves (can't remember that well), but my surgeon chose it for me. I remember he had a few to choose from at the time but felt it was the best for my situation. I am happy with it as it is working well for me so far! Just wondering.
 
Stock market, anybody?

Stock market, anybody?

I have a St.Jude valve. Ten years ago we bought STJ stock. The analysts in New York were against it then because of " increased competiton" and numerous "legal problems".We still went ahead and bought a good amount and it has done very well. On-X without doubt is the valve of the future. There is a currently running study called PROACT which may determine On-X'ers will not need to take warfarin. Maybe aspirin only. This is a big deal. When I last checked with my broker to buy On-x he found it is still privately held. If and when they come out with an offering we will buy and probably dump STJ.
 
Shezagirlie is the only one that I know alive that has one still.

Sandra, not trying to be a smart aleck, but I love this thing:

http://tinyurl.com/dgo2t3
Hi Ross,
:D:D:DIt was the Seth's thread that aroused my interest.:D:D No I don't think you're being a smart alec. The links to the coated valve sites are very well known to me, unfortunately.
 
The carbomedics is an intermediate valve between the original St. Jude model and the On-X. There is a Top-Hat model that can be placed supraannularly (in a natural notch) to allow even more bloodflow as well. They are all creations form the same scientist with different assistants and research groups (see Al's post for links and info - no point repeating).

The On-X uses the only formulation of pyrolytic carbon that does not retain any silicon. It's apparently thought that the silicon creates just enough friction on the valve surface to slow the blood enough to allow clotting.

Most of these valves have shapes that "wash" the pivots and some surfaces. The On-X is particularly structured to do so on all surfaces, and the Carbomedics mentions it in their literature as well. The latest version of the St. Jude is an attempt to catch up with that without damaging the core value of the SJM original.

If you are concerned with bloodflow, you need to look at gradient numbers, rather than valve sizes. Having a minutely larger opening doesn't necessarily improve bloodflow. As can be seen in the attached chart, a larger effective orifice area doesn't necessarily improve the SJM's gradients for the equivalent size valve as On-X.

Best wishes,
 
Interesting thread started by Hot Rod Harry.

I wonder why he has not been back in the last 2 days to read ALL of the responses.
 
Very interesting mention of ..............................

Very interesting mention of ..............................

I have a St.Jude valve. Ten years ago we bought STJ stock. The analysts in New York were against it then because of " increased competiton" and numerous "legal problems".We still went ahead and bought a good amount and it has done very well. On-X without doubt is the valve of the future. There is a currently running study called PROACT which may determine On-X'ers will not need to take warfarin. Maybe aspirin only. This is a big deal. When I last checked with my broker to buy On-x he found it is still privately held. If and when they come out with an offering we will buy and probably dump STJ.

how your "good amount" of stock earned dividends. Two good things though--you were aware, at the time, of "competition" and "legal problems" with SJM.

This confirms the the reason why that valve entered the market--to make money. All valves of course are marketed to make money for their manufacturers. There is nothing wrong with making money either, just how. Very few of that valve's recipients were aware of its tested/untested status as you were aware of the "complications" with its manufacturer.

In Canada that valve was "cheap" by comparison--money again. Now consider what the On-X valve is being subjected to for more than 10 years.

I could go on but I won't. Most valvers feel they succeed because of their valves--not in spite of them. Consider for a moment patient deaths associated with this withdrawn valve--Billy in Ireland's spouse for just one. You might have a different opinion about making money from sick people that didn't know any better and money being spent by the manufacturer on legal bills--not testing the valve--legal bills--lawyers fees.

I wish you well and trust you and your family are healthy.

Sandra
 
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