“On-X For Mitral Heart Valve Replacement?” Asks Vivian

By Adam Pick on August 27, 2008

Vivan has a severe mitral regurgitation disorder and is preparing for mitral valve replacement operation. She is currently considering several different valve types (tissue, homograft, mechanical) and valve brands (Edwards, Medtronic and St. Jude Medical).

Vivian’s question to me is, “Adam – Can you tell me about the On-X valve for mitral valve replacement?”



For those of you who are not familiar with the On-X heart valve device for mitral replacement, here is some basic information for you:

  • On-X was founded in 1994 and is located in Austin, Texas. It also owns Medical Carbon Research Institute in Hanover, Germany.
  • According to the On-X valve website, the primary focus of On-X is (i) improve pyrolytic carbon coating technology , (ii) Advance the performance of prosthetic heart valves, and (iii) provide additional cardiac surgery products that help patients.

As for its valve offerings, the On-X® Prosthetic Heart Valve for mitral replacement is a carbon bileaflet heart valve prosthesis. One of the most interesting highlights of the On-X valve is that in 2006, the Food and Drug Administration approved an IDE (Investigational Device Exemption) lowered anticoagulation trial for its mechanical valve.

The patient in the PROACT (Prospective Randomized On-X Clinical Trial) study include a non-warfarin group of low-risk aortic valve replacement patients and 2 low-dose warfarin groups of higher risk aortic and mitral valve replacement patients.

In case you missed that did not make sense… The significance of the On-X trial is that patients may obtain the benefits of a mechanical valve (duration, lower re-operation rates) without the risks of clotting problems due to lower Coumadin (Warfarin) dosages.

I have also heard that some patients are taking Plavix / aspirin instead of Coumadin in an ongoing On-X trial.

According to the company, over 50,000 On-X valves have been implanted since 1996.

I hope this give you some background on the On-X mechanical valve for mitral replacement surgery. Over the years, I have spoken with many patients that are happy with their selection of the On-X mitral valve. If you have an On-X replacement valve, please scroll below to leave a comment!

Keep on tickin!

Written by Adam Pick
- Patient & Website Founder

Adam Pick, Heart Valve Patient Advocate

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Keith Thomas says on August 27th, 2008 at 3:13 pm

I have a 23mm ON-X aortic valve that was implanted on 8-16-08. I am on low dose coumadin at the present and am expecting to go to aspirin and Plavix soon. I have not had any problems other than noise, I hear it clicking away mostly at night or when it is really quiet. It is supposedly quieter than other mechanical valves so I would hate to hear one of those. I do have really good hearing though. My 13 yr old daughter can hear me from across the room though no one else in my family can. We have fun with it, the noise that is.
Good luck with your operation. KT

Jack9 says on November 13th, 2008 at 12:14 am

I had a 23mm ON-X aortic valve replacement for a 23-year old high turbulence Bjork-Shiley 21mm on 11/3/08. Bjork-Shiley had a high INR requirement, was highly destructive as well as less efficient than even a St Jude by half an order of magnitude. I suffered intermittent atrial fibrilliations for the majority of the 23 years I had that implant and the sound was substantially louder and simpler. A simple click-clack is now a very quiet overlapping click->click pause. Outgrowing my previous valve I incurred signifigant hypertrophy which was corrected during the on-x replacements. Also, I never suffered from headaches or migranes (without exceptional fever or poison).

Mitch Gold says on February 21st, 2009 at 3:58 pm

I have an ON-X mitral valve that was put in 15 months ago.
So far so good. I feel better after a recovery year. The intitial recovery was 2-3 months. It took about a year to feel better than before the surgery. The ON-X valve seems fine-It can be noisy in bed at night when I lay on my back. I recommend strongly that you get a home test kit to measure INR level weekly.

Detral Hall says on March 4th, 2009 at 10:42 am

I had a redo mitral valve surgery in 11/2006. I have a 25mm On-X mitral valve. This new valve is now leaking. I am looking at a 3rd surgery. This valve is leaking. According to the TEE performed 2/11/09. There is moderate regurgitant jets coming off the sides of the closing bileaflet structures. There is also a moderate/severe central regurgitant jet.

Clarissa says on August 1st, 2009 at 7:37 pm

I had an ON-X Mitral valve and a porcine pulmonary valve put in on July 6, 2009. I already can tell a difference in my breathing. The On-X valve is noisy when it is quiet. But I would rather hear a nice steady beat then all the leaky noises. The only problem I had is I am not a pain person and my ribs hurt soooo bad. But I guess that goes with the saying…no pain no gain….Thank God for giving doctors and other people the knowledge to fix heart valves!! 🙂

Angel Trasobares says on December 1st, 2009 at 1:51 pm

I was diagnosed with Mitral valve prolapse on October 20, 2009. A few days later, I found myself in the OR having an ON-X 30mm valve installed in place of my own heart valve. I’m 37 years old and never thought I’d be going through the recovery process of an opn heart surgey. I LOVE the ticking noise that my valve makes. I look forward to hearing every second of the day. I find it’s the cadence for my new life. Thank you Adam. Without your book, my Mom would not have felt so at ease with this whole process. I thank God for all the prayers and support from my friends and family. Also, i’m grateful for this new ticking sound. Come to think of it, it’s not so bad after all.

rasanna fregoli says on February 18th, 2010 at 11:47 pm

Hi Adam,just got your book !it’s very informative .I am 58 years young ,and have history of rheumatic heart desease ,when i was 20 i had valvulotomy done on the mitral valve ,back then they made an incision under my left breast ,to clean the valve,they told me that after 10 years it would have to be done again ,well it lasted 28 years! But unfortunatly in 1999 the valve was closing again from calcification,they did a baloon procedure called CBC ,well in 2005 started to have AF ,and they put me on warfarin 2mg my INRwas supposed to be kept at 2.0 to 3.0 range didn’t want to take the stuff,but i did .Two years later had a bleeding event in the gastrointestinal area ,they reversed me ,and since then never had a bleeding problem becsuse they told me to keep the range at 2.0 to 2.5 it’s been 5 years.but recently i have gone into heart failure ,been cardioversioned 7 times ,but medications do not control the A.F,Took TEE ECHO and my aortic valve along with mitral have to be replaced .Which way should i go mechanical or bioprhostetic? No one will give you a straight answer ,mechanical with risk of bleeding,or bioprhostetic with risk of redo operation ?my operation is scheduled for the 24th of feb.my husband and i are very scared and frusrtated your comment please ADAM thank you

MICHAEL MITCHELL says on April 30th, 2010 at 3:47 pm


Sneha says on August 4th, 2011 at 5:00 am

Hi i am Sneha from India.My brother who is 22 is getting a valve replacement surgery done.I would like to know which valve is the best in his case.He has a long life to live.Also,is the ticking sound very distracting?

JC Arsenault says on August 15th, 2011 at 7:24 pm

I had mitral valve replacement with the ON-X valve in 2007. They replaced my aortic valve at the same time with a biological valve (calf)
I am interested in the results of the tests which were conducted on lower Warfarin dosage. The hospital currently keeps my INR over 3, which I find high. I would like some material to induce the hospital into lowering my Coumadin dosage.

JC Arsenault says on August 15th, 2011 at 7:32 pm

About the ticking, I am a little bit deaf, It helps. I only heard the ticking a few times and got used to it very rapidly. It kind of comforted me; the ‘thing’ was working…

The life expectancy of a mechanical valve seems to be about 5 years longer than a biovalve. And the ‘noise’ is no longer loud as it used to be.

Vida Lee Todd says on February 8th, 2012 at 12:25 pm

We are having children returning to our Pediatric Cardiology Clinic, with your value placed. Please send me the normal pressure values for the various sized values, I require the echo values for our clinic for the various sizes.
Would you please either email me or you can mail them to me

Vida Lee Todd
Pediatric Cardiology
Pediatric outpatientss
103 Hospital Drive
S7N 0W8

Rosanne B. Holderried says on April 5th, 2012 at 11:59 am

I am post op five weeks. A On-X mitral valve was replaced, my starr-edwards valve of 4l years was explanted and replaced with the On-X I am still in the recovery period and I have heard this is one of the best valve, what scares me is the things that can go wrong, this has been my third open heart and I know I will not be re-operable if anything should go wrong, hope all goes well I feel it is to soon to notice any differance. The asd was also replaced along with the tricupis valve. It was not an easy operation. I hope to hear more comments on positive aoutlooks regarding this valve. As for the noise nothing beats the starr edwards valve. I do miss it.

Rosanne B. Holderried says on May 17th, 2012 at 11:01 pm

I had an Onx heart valuve put in Feb. 29, 2012 at Cleveland Oh. a starr edwards was x planted and replaced with the onx so far so good. I do miss the noise from my starr edwards I had it for 41 years. I understand that this value is the state of the art ? Hope it last longer than the starredwards.

Steve Lower says on May 1st, 2014 at 4:26 pm

My aortic valve was replaced with an On-x more than five years ago. My cardiologists luckily encourgaged me to do valve research and the On-x was a no brainer. At that time it was difficult to find a surgeon that woud use the On-x but after contacting the company I was put in touch with the right team.

I took blood thinner for about the first year then after following all the research closely decided to use one adult asprin a day only, no Plavix. My cardiologists was a little nervous when I told him my new plan so he ordered an immediate echo. The echo test was fine so I continued with my program. I’ve had an annual echo ever since with no issues. My open minded cardologists says don’t change what’s working. I might note that I dont mind taking chances and wouldn’t recommend this plan to anyone else unless they’re in good healt. I’m 63, vegetrian, and run ultra marathons. Can’t imagine why anyone would want any other kind of valve.

mayank sagar says on May 23rd, 2015 at 6:54 am

Hi m working as a free lancer in india providing quality treatment to patients coming across the world sir there are several comp.in india for that reason. I am providing same treatment at five time cheaper than these companies. If anybody need my service may contact at stressfreetreatment@gmail.com

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