Supra Annular Valves

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WillieR

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Dec 23, 2017
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All,

I'm about 1.5 weeks out from surgery and 90% sure I'm going with a mechanical valve. 32yr old male. The decision comes down to either the On-X or a supra Annular valve called the Carbomedics "Top Hat". Most know the On-x has the lower INR range so that sounds appealing, but my surgeon also said the supra annular valves are good too because they sit above the Aortic root and therefore the he can place a slightly larger valve. This should lead to a lower gradient and possibly reverse any Left Ventrical growth and bring my LV back to "normal" range; right now I'm just barely above normal. Curious if any others have heard about these supra annular valves and if there is a proven advantage to getting the larger size valve.

From all my research it seems like most people are going with the On-x valve so I'm leaning that way.
 

pellicle

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WillieR;n882561 said:
From all my research it seems like most people are going with the On-x valve so I'm leaning that way.
while I see nothing wrong in the On-X valve I would tend to prefer the valve your surgeon prefers working with. IMO the reduced anticoagulation is pure "marketing" and in reality there is nothing inferior about the St Judes or the Carbometrics (I have an ATS which I undstood was purchased by Carbometrics).

The larger size does seem to have the advantage of lower incidence of pannus obstruction growth.

I was tending towards the On-X myself before my surgery, but that was based more on the anti-pannus aspect. However (in the letter I wrote to my surgeon) I stated that I'd be guided by what he preferred ... I have no issues with the ATS I have and I must say at least feel some level of comfort in the actual historical evidence of its success (rather than just claims).

Oddly I had no interest or concern about INR management before surgery (nor after it really).

Best Wishes.
 

tom in MO

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I have a St. Jude, but could have had an On-X. My surgeon preferred the St. Jude and I went with his suggestion. He liked it over others primarily due to its "long track record" and he saw no benefit to the On-X. The St. Jude has a INR range of 2-2.5 and can go very low w/o bridging for some operations.
 

mainframe

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I have a Top Hat valve and being able to place a larger valve above was one of the reasons the surgeon felt that was the correct valve for me.
 

WillieR

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Dec 23, 2017
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Minneapolis, MN
pellicle;n882568 said:
while I see nothing wrong in the On-X valve I would tend to prefer the valve your surgeon prefers working with. IMO the reduced anticoagulation is pure "marketing" and in reality there is nothing inferior about the St Judes or the Carbometrics (I have an ATS which I undstood was purchased by Carbometrics).
Pellicle, I too am a bit skeptical of the lower INR marketing of the On-x, even though it is FDA approved. Additionally, one of the surgeons I consulted with at Mayo Clinic did not think that anyone should use those lower guidelines even with the ON-X. I don't remember exactly how he put it but it was something along the lines of 'any doctor with that knows what they are doing won't recommend the lower ranges'. It does give a little peace of mind though if you dip below 2.
 

pellicle

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WillieR;n882613 said:
It does give a little peace of mind though if you dip below 2.
That's pretty much how I see it.

Broader reading over time has brought me to the view that without other complications, the modern bileaflet pyrolytic carbon valves are ball park.

Most papers on the subject suggest that short term unanticoaulated exposure is low risk and some go as far as suggesting we are overly anticoagulating most of the time.

I myself feel quite comfortable between 2 & 3 as research has suggested thats the place where minimal thrombosis occurs and minimal bleed events occur.

You may find this interesting reading, how I handled my perioperative INR management
http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html

Best Wishes
 
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