what to do (St.Jude vs. On-x)

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scuba_898

Well-known member
Joined
Apr 30, 2009
Messages
79
Location
Sugar Hill, GA
I saw a surgeon on Monday and he said its time. he wants me to have surgery in the next month or two. he wants to put a st.jude mech in me. I have read a lot about the on-x valve, and from what i have read think that it is superior. he for whatever reason said that he is not a fan of the on-x. I have read that a lot of other well known surgeons prefer the on-x valve. so i don't know what to do. my wife and family think that i should trust my docs recommendation and not play doctor myself, I do, I just like what i have heard about the on-x better.

another question is do i have time to get a second opinion on this. I know that CC is real good, kinda far away since i'm in ATL.

The next thing that i am doing is scheduling a heart cath with a new cardio today. the cardio is being recommended to me from the surgeon, since i was unhappy with my original cardio. on this is being done from test that i had 5mo. ago which my cardio then said wait, which the surgeon says time to go. I appreciate any advice yall can give me.
 
scuba_898 said:
I saw a surgeon on Monday and he said its time. he wants me to have surgery in the next month or two. he wants to put a st.jude mech in me. I have read a lot about the on-x valve, and from what i have read think that it is superior. he for whatever reason said that he is not a fan of the on-x. I have read that a lot of other well known surgeons prefer the on-x valve. so i don't know what to do. my wife and family think that i should trust my docs recommendation and not play doctor myself, I do, I just like what i have heard about the on-x better.

another question is do i have time to get a second opinion on this. I know that CC is real good, kinda far away since i'm in ATL.

The next thing that i am doing is scheduling a heart cath with a new cardio today. the cardio is being recommended to me from the surgeon, since i was unhappy with my original cardio. on this is being done from test that i had 5mo. ago which my cardio then said wait, which the surgeon says time to go. I appreciate any advice yall can give me.
Click to expand...

If your surgeon hasn't used the on-x valve before, I personally wouldn't want to be his first case. I would get a second opinion from another surgeon.
If it were me, I would chose the on-x over the St. Jude. I don't think it's a matter of "playing doctor". I think it's a matter of reaching a decision concerning a valve that will take up residence ;) in your heart for hopefully the rest of your life.
 
I do not know what I would choose today if I needed another replacement. I can only say that I am extremely happy with my St. Jude which has been in place for 15 years.

That being said, I would just come right out and ask your doctor why he is not a fan of the On-X if that is the one you want. I am sure he must have more detailed information. If he shares that information, it might help in your decision.

I do not think you could go wrong with either valve. However, if you like and trust your surgeon that needs to play into the final decision. If you have no history with the surgeon then you can always look elsewhere for one that will respect your choice.
 
I second what Mary said. I got a tissue valve but if I had gone mech. it would have been Onx.
 
Your Questions sound similar to the ones you posed in the Pre-Surgery Forum.

Here is a copy of my resonse to that thread.

----------------------------------------------------------------

Do a Search on VR.com for keyword "Bokros".

Jack Bokros, Ph.D., and his group developed Pyrolytic Carbon for an application in the Nuclear Power industry. It was later discovered to have good compatibility with blood and St. Jude worked with Jack Bokros to develop the FIRST Bileaflet Mechanical Valves. He has been designing Heart Valves ever since (for over 30 years).

Would you prefer his FIRST Design (St. Jude) or his Latest and Greatest, (On-X) reflecting all that he has learned about valve design in the last 30 years?

The On-X valve has the latest (patented) Pyrolytic Carbon design which is Smoother and Stronger than the original AND it has NO silicone in it (used for strengthening the earlier materials) resulting in a smoother surface that has a Lower potention for clot formation (not to mention smoother pivots and 'edges').

The On-X is the ONLY valve (tissue or mechanical) that has a Barrier to retard or prevent Pannus Tissue Growth from impinging the leaflets. There have been NO reports of Pannus Growth impingement on an On-X in the 12 years they have been in service per Catheran Barnett, R.N. of On-X.

One member who received an On-X valve posted that the Echo Tech couldn't believe that he had a mechanical valve because s/he did not see any turbulence during his post-op checkup.

You may want to ask Dr. Wolfe (at Peachtree Cardiovascular) about his opinion of the On-X valve vs. St. Jude. (Edit: I have been told that he does use the On-X valve).

Or ask Dr. Puskas, at Emory University. He is the one heading the No / Low Anticoagulation Study with the On-X Valve. I'm thinking that Dr. Puskas is chief of cardiothoracic surgery at Emory. (need to check that)

Dr Pettersson (one of the most highly regarded Surgeons at Cleveland Clinic) is another advocate of the On-X Valve. See comments from "ctyguy" who received an On-X at CC / Dr. Pettersson.

Call On-X and ask for their Information Package to get more details (888-339-8000) or e-mail [email protected]

Bottom Line: From what I have found in my research, if you want an On-X Valve you have 2 choices:

1- Find a Surgeon who already uses On-X

2- Persuade your Surgeon to give you an On-X.

Several of our members have done this and were their surgeons First On-X patient. Follow-up reports indicate the surgeons liked the On-X and have begun using it with other patients.

On-X will send a representative to 'educate' the surgeon about their valve and recommended procedures for sizing and implanting.

As I said above, Dr. Wolfe at Peachtree Cardiovascular uses On-X as well as most/all of the surgeons at Emory University (and Dr. Petersson at CC).

Long Ago I made a post that included Valve Performance Data for the 4 major mechanical valves. I believe that was in a thread entitled "St. Jude". I'll see if I can find it.

'AL Capshaw'
 
How about call On-x and see if there is a Dr. in your area using their product that you can consult with.As patients valve choice is one of the only decisions we get to make.
 
Here are copies of parts of my posts in response to the "St Jude" thread from December 2008 to January 2009. The comparison data is in the second post.

Here is the link to the entire thread:
http://www.valvereplacement.com/forums/showthread.php?t=28571

========================

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 (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 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*.
====================================

Here is the Valve Comparison data:

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'
 
thanks for all the help...

AL... the surgeon who i saw is Dr. Kauten, who is in the same surgical group as Dr. Alan Wolfe. So i believe that kauten is familiar with the on-x and may have used it before. I don't want to offend him by seeing another surgeon in the same group. I guess i could discuss this too with the cardiologist.

I did email on-x yesterday about this too. they sent me letter back saying that i am fortunate to be in ga, as the on-x valve is the market leader down here. the letter also gave me two names Dr.Puskas, who is head of low-dose cumadin study and is out of emory, here in atl. it also gave me Dr. Alan Wolfe, who uses the on-x a lot, and again he is in the same practice/surgical group as the surgeon i saw on monday.

so i am still unsure, i really don't want to offend the surgeon that we saw, by seeing another surgeon in the same group, since we liked him. however i still want to make sure that i get the best valve available, which he wants mech. so i say on-x. what do you all think. I am sorry if it sounds like i am beating a dead horse here. just trying to get this all out of my head. thanks again.
 
I just added the Comparison Data to my previous post.
Did you see it?
If not, scroll back to that post to check it out.
I also added the link to the St Jude thread from Dec 2008/Jan 2009.

I see that On-X gave you the same names that I came up with in the Atlanta area.

You need to get over your fear of offending the first surgeon you spoke with.

I see a couple of options.

Go back to Dr. Kauten and ask him specifically why he does not like the On-X valve. It may be that he simply has NO experience with it and is most comfortable with St. Jude because that is what he has used for the past XX years. It may also be that he simply has NOT evaluated the On-X thoroughly and does NOT know the details of its Technological and Performance Improvements. You could educate him or ask if he would be willing to talk with the Atlanta Representative from On-X. I'm sure On-X will provide that information.

You could then ask if he would be willing to use it on you.
If his answer is NO, then ask if he would mind if you consulted with Dr. Wolfe.

I would think that you could get a second opinion at Emory without the need to advise Dr. Kauten of that act. Dr. Puskas personally called me back after I had called his office with some questions I once had. It's worth considering.

From my perspective, when a patient wants a particular Valve or Procedure, he needs to Search for a Surgeon who has Knowledge and Experience using / doing what the patient wants and needs.

Bottom Line:
NOT ALL Surgeons are familiar/proficient with ALL of the Valve Options (or surgical procedures).

The alternative is to just accept whatever the first surgeon you consult proposes and live with it. It IS Your Decision.
 
I dont think for a moment you're playing Doctor, it's your body after all ? The thing is, it's not a simple black and white thing. Some surgeons favour St.Jude and some On-X, I guess some prefer St. Jude for no other reason than it's been around a long time and works very well.
If you want an On-X then ask surgeon number one why he dosn't want to use it in the first place ? If he's no good reason then just go to another surgeon, dont worry too much about offending, it's just another day at the office for him and you're just another punter, he wont loose any sleep or give it a second thought, whereas you probably cant think about much else at the moment, so it's only right to put yourself first and get what you want.
If I had the choice all over again I'd probably have chosen tissue ? Not to confuse you further, but if I had to choose between mech valves it would be On-X, purely because it's designed by the same people that put the St.Jude together all those years ago, altered, improved and made from more advanced materials with decades more valve experience ?
 
I would want the On-X. My research agrees with Al Capshaw's information.

It's currently in trials for anticoagulation with aspirin only (no coumadin), and I note that the trials haven't been halted for any problems so far. If that gets approved, and you have just gotten a St. Jude Regent implanted (which will still require Coumadin), how will you feel about your doctor's opinion then?

If you believe in it, insist on it. It's your heart. It's really no skin off his nose, and you have no reason to be loyal to his favorite valve salesperson.

Best wishes,
 
As much as I love my surgeon who did my mitral replacement with a St. Jude's, when my cardio pulls the trigger on my aortic replacement, I'm going On-x to minimize cell damage and turbulence. If he won't do it, I'll find another surgeon.
Get what you want, though both are good valves.
 
I agree with the others that you should get the valve you want unless the surgeon has a very good reason why it is not best for you.

I chose tissue valve and am happy I did but if I had to choose mechanical, it would be On-X.
 
Hi...so I see you met Dr. Kauten. It does sound like him to not say exactly why he doesn't like the On-X, and I would push the issue if that is your preference, as others have said. He gave me a Carbomedics but mine is a MV. I would not say use him or not, but about CC, my brother lives in Miami, FL and told our cardio at the time that he would travel anywhere to have his MV repair, and was recommended Kauten, who as I told you he used as well. I was also told not to see another surgeon within the practice b/c it would offend (is this a polite southern thing or a dr. thing?) but I don't see why not at this stage in the game. You've only had a consult with him.
My final adivce is if you are not comfortable with it, don't do it, find someone who will work with you, and at least begin by getting a straight answer out of Kauten. I told you he doesn't say much.... when my family was waiting for me after OHS #2 he came out and they were like "well....." and he was just like, she's fine but they had to push him for details. So I would say do the same! He is an excellent surgeon otherwise speaking, though, but there are lots of good ones in ATL for you to choose from.
I was just curious who your cardiologist is that you were referred to?
 
Given the seriousness of this surgery and the major choice involved regarding the valve- should we really worry that much about offending a surgeon by getting a second opinion ? From what I've heard many of these surgeons think so highly of themselves (and maybe rightly so given the miracles they perform) that this probably wouldn't even put a dent in their ego. As someone said - it's just another day at the office. You're the paying customer here and should get what you want with whomever you feel the most comfortable with. I agree it may be awkward and I may be facing the same thing as I go surgeon shopping, but it is what it is and I won't let that stop me from doing what I think is best for me.
 
I had the same thing back in 2007 before I got my surgery. I requested On-X even though it would be the first at Washington Hospital Center and the first by my surgeon. Its working great, and I have no regrets. Quite the contrary: I'm more convinced today that I made the right decision. Its your body and you're going to have to live with the decision for the rest of you life. Good luck, whatever you decide.
 
From what I know both are fine valves ... as others have said I would want to have a surgeon experienced with whichever valve I choose .... I’m very happy with my St. Jude but the on-x is a good valve too ... I don’t think you can go wrong with either .... best of luck....
 
what to do?

what to do?

.what to do? you ask.

well, the awnser is simple, do what you want to! its your body.

the surgeon i used only implanted an on-x because i demanded it. he said it was the last thing he would stick in his body and, obviously, had never implanted one before. neither had the hospital. in the event, he had no trouble implanting it. may i suggest that a surgeon who can not manage to implant an on-x is a surgeon best avoided.

the on-x was always plan b for me because i was almost guaranteed a mitral valve repair. despite the surgeons particularly valiant attempt, the repair failed and i woke up with an on-x valve.

as i lay in icu i had time to reflect on the wisdom of over ruling my hugely experienced surgeon; i did wonder if i had out smarted myself this time!

but every doctor and specialist now conceed that my on-x has worked out brilliantly in all respects. our gp says my on-x valve is so quiet he can not even hear it with a stethoscope and would never guess my medical history if he did not know it. his hunch is that better engineering is the reason it is so quiet and that i have made life a lot easier for the next person who wants an on-x valve implanted!
 
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