Charles's Journal

Hello again from the other side. Luckily, I was part of the 98%. Made it thru the surgery this past Friday fine. The wait was worse, and glad it is over. Recovery so far is going well, even better than last time. And I had a full sternotomy this time vs. mini-sternotomy “keyhole” last time in 2013. Then, my enlarged ascending aorta was replaced with Dacron graft. Now the unicuspid valve, which was diagnosed as severely stenotic with calcification, was very heavily calcified. Currently on day 4 and very minimal pain. Just acetaminophen for past 2 days. Fentanyl for ICU was effective but short lived and with wild side effects. Hallucinations, go from chills/shaking to sweats even though temp was normal. Guess I don’t have to worry about becoming an addict! Surgery done at Cleveland Clinic by Dr. Lars Svensson (same as first surgery). Was in ICU for 2 days which is minimum protocol now. Had 4 drain tubes vs. 2 last time. That part sucks when they remove the tubes, although feels better when out. Was walking on day 2 in ICU. They said I could have been released today due to my recovery, but have to wait for INR level to drop before heart wires can be removed. So, probably Thursday with wire removal tomorrow. The valve. So, as I mentioned in a previous post I spoke with surgeon right before surgery and left the final decision to him as to which specific valve would be best for my anatomy. So even though he was a SJM proponent and I thought we were going in that direction……he sized both brands and determined that the On-X was best for me. So, I now have a 23mm On-X. I’m fine with that as it was my first or initial choice. I believe they are very similar with minimal unique characteristics. Valve noise: I can’t really hear it, and I have very sensitive hearing. It was even hard using the stethoscope. It is very muffled. I’m wondering if the Dacron graft combined with the chest muscle are noise suppressing. Thanks for all of the very helpful information. A final comment. I strongly recommend the Cleveland Clinic for any heart related issue. Simply the best. I noticed improvements in the process since 2013.

Currently sitting in the surgical waiting room at the Cleveland Clinic. The time has come. Scary times but will be glad when it's overwith! The cath came out great with all clear so that may help speed things a little.

I'm currently in the research phase of aortic valves. Reached out to technical folks at CryoLife on the On-X valve with durability/cycle testing questions. Received a quick response back that others may find useful and interesting. Will cut & paste the info below. Great data! Response: Your main question regarding the durability of mechanical valves (how long will they last) is a good one. Valve companies must provide accelerated wear testing data (Accelerated Durability) to the FDA. The companies follow a very strict and standardized protocol where we rapidly open and close (cycle) the valves through 600 million cycles. This is done on a high speed tester with many valves being tested. The tester has the valves opening and closing so rapidly that you need a strobe light to see the valves cycling. 600 million cycles is 15 years of valve opening/closing. This process can take approximately 3 years, as we remove the valves from the tester at various intervals to measure the carbon wear depth. After the 600 million cycles is complete, the companies will then take their valves and measure the wear depth against a maximum allowable wear depth level. At this point you can get an idea of how much wear occurs over 15 years, and then extrapolate out the wear data until it crosses over the maximum allowable line. In doing this, we can prove to the FDA that the On-X valve will not ‘wear out’ during the lifetime of any patient, and some have extrapolated out to nearly 200 years of opening and closing. In the On-X valve Clinical Evaluation Report, we have entered 99 years of wear as our official number and it also states that the On-X valve will not wear out over the course of a patient’s lifetime. The On-X valve was implanted in the first patient on September 12th, 1996 and the valve assembly has not changed since this time. On-X aortic valve was approved by FDA in 2001, so there is a long established track record of excellence, safety and effectiveness of the On-X valve.