Mitral Valve Repair...mini-thoracotomy or partial upper sternotomy?

[deek]

I'm scheduled for Mitral Valve Repair March 20th and need to decide on having a "right mini thoracotomy" or a "partial upper sternotomy". My surgeon said it is my choice and that he's equally comfortable with both. What are the advantagess vs. disadvantages of both....besides the obvious, which of coarse is cosmetic? I'm a 35 year old female but the idea of a scar doesn't really bother me at this point in my life. Also, I probably should mention that it's very likely that I'll have to have another repair or replacement in the future as I have malignant hypertension and as I'm sure most of you know this only makes valvular regurgitation worse and I currently have moderate AR as well.

Thank you in advance for your help!

Deek

 

[Nupur]

Hi Dee, what is your back up plan for a replacement? A tissue or mechanical?

All the best.

 

[Lynlw]

I can't offer suggestions, but am sorry to hear you were dxd with malignant hypertension, have they been able to get your pressure under better control?

 

[deek]

Hi Nupar! I see that you are scheduled to meet with a surgeon too. I've noticed that our echos/tee results are quite similar from prior posts and we are about the same age with a young child. I wish you luck with your consult. Meeting with my surgeon was actually a relief...he made it easy by just telling me straight up that I needed an operation. I don't know about you but I just want to get it over with. He pretty much guarentteed a repair (99%) but I'll probably go tissue as another surgery is likely given the malignant hypertension anyway. Let me know how your consult goes.

Lyn - Thanks! I've been seeing hypertension specialists all over to know avail...nothings worked thus far and no one knows why? I'm on 10 meds, one being the "last resort drug" minoxidil...this has helped somewhat...putting me at an average of 170/95. My hypertension specialist is hoping the MVR might help although he thinks it unlikely.

 

[Lynlw]

Lyn - Thanks! I've been seeing hypertension specialists all over to know avail...nothings worked thus far and no one knows why? I'm on 10 meds, one being the "last resort drug" minoxidil...this has helped somewhat...putting me at an average of 170/95. My hypertension specialist is hoping the MVR might help although he thinks it unlikely.[/QUOTE]

I'm sorry to hear that, I was hoping it was one of those no news is good news things when you didn't post much about it. Even tho it is a small chance I'll pray the valve helps get it under more control, have you had any of the other organ issues that can go along with it? Having something that is rarer isn't fun, I tell Justin, boring is good when it comes to medical things.

 

[deano89]

hi deek
i asked my cardio if i could have minimal invasive but he said the surgeon will do sternoctomy, which after giving it some thought i think this gives the surgeon more room to work which i am ok with especially as mine its a bit more of challenge to repair ,
dean

 

[Cooker]

I guess my question is what if they can?t repair and need to replace, what is the best option under that situation? ... I had no problem with my full sternocotomy, I know some do but we can?t see the future ... Wishing you the best.

 

[deek]

Cooker,

I guess I never thought of that because he was so sure he could repair...those are the options he gave....thanks, I guess thats a question I need to address to his office.

 

[Lisa in Katy]

Malignant hypertension is a new one on me. Any idea what causes some people to have it? Is it a genetic thing? Is it affected at all by diet, exercise, etc.?

I had the full sternotomy, but there were no other options at the time. My scar is horizontal so is hidden in everything except plunging necklines, bikinis, and nudity, which I try not to do too often! There was a recent thread where some people said the mini thoracotomy can actually be more painful because it cuts through more muscle. Also if you already have moderate AR and they expect it to get worse, why aren't they fixing it at the same time? Seems to me that this would decrease the time before you need another surgery.

 

[DebbyA]

Hi Deek,
Last year I was given those options for AVR. I called my cardiologist, reasoning that she'd have feedback over a longer period than the surgeon. I was honestly more interested in comparing pain than appearance. She called the surgeon. It turned out that though he'd done thousands of traditional valve replacements, he hadn't done that many using the mini-thoracotomy. She recommended the sternotomy because there is less chance of nerve or muscle involvement, and that's what I had.
My understanding is that some have found the thoracotomy very painful, and there is a slight possibility that you'll end up with both. However, the healing time is faster than sternotomy.

 

[deek]

Lisa,

It's my understanding that the AR improves under better pressures and is functional whereas the MR does not and the valve itself is severely prolapsed. They are hoping to eventually control my blood pressure despite not having been able to for a year and a half now so I won't need a AVR. The refractory/malignant hypertension has made my case a questionable one to say the least and has brought forth a lot of frustration for me and my many physicians.

Debby,

Thank you for the information. This is what I was looking for. I, too, have heard that the mini-thoractomy is much more painful because of the nerves and muscle. I had a pacemaker inserted intermuscular over a year ago and this hurt a lot compared to the traditional way of insertion. The positive is it doesn't stick out there like most do.

 

[AndyChas]

Hi Deek

I had a mitral valve repair done by a mini thoracotomy four weeks ago. My recovery has been very good, albeit with a few small ?bumps? I hadn?t foreseen.

As Lisa points out, the potential pain of the mini thoracotomy was discussed in a fairly recent thread. Although I can?t compare the thoracotomy with the sternotomy, I can say that I didn?t experience too much pain. The only time I really was very uncomfortable was during the echocardiogram the day after the operation, and that was mainly due to the uncaring idiot performing the test. I was released from hospital after five days (a fever kept me there an extra day) and was able to cope quite well with just paracetamol/codeine until about a week ago, when I was able to stop that as well. I still feel some discomfort, particularly in the morning, and I can only lie on my side for short periods at this stage. Apart from that, in most ways I?m back to normal, albeit being careful about lifting heaving things with my right arm: I?ve been driving and going to the gym and rehab for two weeks now, and started cycling again recently. However, I think it will be a couple more weeks before I could swim without worrying about internally irritating the chest wound.

I?d also be a bit wary of swimming due to the appearance of my chest: I?m slim and don?t have much in the way of man-****s, but my right breast is still swollen and numb, and I?m sure people at the pool would stare. It?s hard to describe, but the swelling is very prominent near the armpit, and the nipple seems to point down instead of ahead (this has started improving over the past week or so). As you are different to me in this respect, it's hard to say what the visual impact would be! On the positive side, I?m sure the swelling will subside soon and I?d guess that the 4cm horizontal incision will barely be visible in a month or so (it will be largely hidden by the shape of the chest, while the drainage tube scars and a few other small incisions are completely hidden in the armpit). There?s also a 4cm incision in the groin from the life support machine, and mine?s quite swollen at present (but not painful).

Two nurses told me the thoracotomy pain is usually worse in well-built men due to the extra muscle that has to be negotiated to get to the heart. I was treated at one of the major heart surgery hospitals in Australia but I seemed to be the only person on the floor who had a mini-thoracotomy. Another advantage (I think) is that only one lung needs to be collapsed during the operation to access the heart: I certainly didn?t have the same problems others in my room did with getting lung function back (the coughing and hacking required to do this would seem to be a large part of the post-operative pain factor). That said, coughing and sneezing still hurts quite a bit even now!

Hope this helps,
Andy

 

[Nupur]

Dee, I am glad your chances of repair are > 99. But as the wise folks here would say, you must have a definite plan B. Good luck!