Dr. Jack Holt is a cardiothoracic surgeon who has been practicing in Daytona Beach, Florida for the past 25 years. He is a member of the Atlantic Coastal Cardiovascular Thoracic Associates and has performed many heart valve replacement surgeries over the years, with both mechanical and tissue valves.
Mechanical vs. Tissue Valves
“I’ve been putting in tissue valves for a long time. But there’s been a real trend toward mechanical valves now because of the new technology with the On-X [Aortic Valve], and the fact that you can get away with low dose (INR of 1.5 – 2.0) Coumadin (Warfarin),”1 Dr. Holt said.
The On-X Valve has not only had a significant impact on patients’ lives, it has also affected the way he consults with patients about heart valve replacement.
Because of the durability of the On-X Aortic Valve2 and the lower requirement for anticoagulation therapy,1 Dr. Holt believes an increasing number of patients will be choosing to receive the On-X Valve.
“The durability of a mechanical valve is a key aspect to consider, particularly in younger patients who want to avoid additional operations,” Dr. Holt said. Tissue valve durability is a limitation which can lead to valve failure and require replacement as early as 5 years, especially in patients less than 65 years old.3,4
“So you’re looking at a re-do (reoperation), which is not a benign procedure; whereas this mechanical valve can last you your entire life, essentially.”1,2
With the On-X Aortic Valve, patients can now be 50% closer to a normal INR5 (1.0) with their anticoagulation therapy, which means they have a significantly less risk of bleeding.*
“Because of the new technology with the On-X [Aortic] Valve, and the fact that you can now shoot for INR’s of 1.5 to 2.0, it’s much more attractive for patients,” he said.*
Dr. Holt has performed numerous valve replacement surgeries using On-X Valves, and he says all have done extremely well. In several of those cases, he explained to patients why the mechanical valve was the better option for them rather than a tissue valve. One such patient was Gigi Arena.
“When I first met Gigi, she was totally convinced she wanted a tissue valve because she did not want to take blood thinners,” Holt said. “But because of her size, she was going to require a very small valve, and that creates problems” for example, not allowing adequate blood flow in relation to the demands of the patient’s body size, which is referred to as patient-prosthesis mismatch (PPM). Also, if her tissue valve fails, a Transcatheter Aortic Valve Replacement (TAVR) Valve in Valve (VIV) procedure would not be recommended for her due to her small valve size and further risks for PPM.2
[TAVR Valve in Valve is an aortic valve replacement procedure in which a new tissue valve is placed inside a failing tissue valve.]
“[A tissue valve] really was going to be a problem for her,” Dr. Holt explained. “So the best option for her was a mechanical valve, and the valve that obviously is the valve of choice today is the On-X [Aortic] Valve. That is because the anticoagulation requirements are significantly less compared with all other mechanical aortic valves.1
“We met maybe three or four times in the office. Every time we met she had questions. She did her homework. She talked to the [On-X Valves representative], and over a period of about a month she came full circle. She came back to me and said ‘I want the On-X Valve.’ And I think that was the right choice for her.”
Another of Dr. Holt’s patients was a 55-year-old woman who had a tissue valve placed 15 years earlier.
“They were thinking of possibly doing this Valve in Valve technology. But she’s really young, and it was going to be a problem for her long term. So, we again sat down and talked, went through the options, and we ended up removing her tissue valve and placed an On-X Valve. She’s done extremely well with that,” Holt said.
Dr. Holt also had a patient with chronic obstructive pulmonary disease (COPD) who was considering a TAVR procedure.
“However, those [TAVR] valves don’t have long term durability. I looked at his pulmonary functions and I felt he could tolerate an operation. It took some talking, and he came back to the office two or three times, but finally after he did his homework and research, and we answered [all] questions for him, he elected to go with the On-X Valve. He did extremely well with the surgery and he’s extremely happy.”6
Heart Valve Choice
Dr. Holt said a patient’s decision on the type of heart valve they receive is a personal choice, and each patient is different. But, he believes it is important for patients to do their own research and consider all their options.
“As a young patient, there are a lot of options out there. You can talk about Ross Procedures, you can talk about, obviously, tissue valves if you don’t want Coumadin. My patients like the On-X Valve because of its durability – the fact that they’re going to get one operation and it will last, hopefully, the rest of their life.2
“[The On-X Aortic Valve] has long term durability, [allows for] low-dose anticoagulation, and personally if I needed an aortic valve, I would pick the On-X Valve,” he said.
* After 3 months standard therapy.1
- On-X Prosthetic Heart Valve Instructions for Use with INR 1.5 – 2.0.
- Nishimura R et al., Circulation. 2017;135:e1159-95.
- van Geldorp M et al., J Thorac Cardiovasc Surg. 2009;137:881-6.
- Wang M et al., Ann Thorac Surg 2017;104:1080-87.
- Normal INR is considered 1. WHO Expert Committee on Biological Standardization, 33rd Report, World Health Organization, 1983. http://apps.who.int/iris/bitstream/10665/39217/1/WHO_TRS_687.pdf, downloaded on 06/29/2016.
- Dvir D et al., JAMA. 2014;312(2):162-70.