"Heartport" Port Access Minimally Invasive Surgery

[selma]

Hi,
I've been reading up on various "minimally invasive" procedures as part of my self-education. One of our local hospitals claims to be a leading "Heartport" center (evidently, they teach others how to use this system. I presume "Heartport" is some sort of proprietary system of valve repair surgery. Anybody here had it? Pros? Cons? There appears to have been some controversy over it. Is "DaVinci" another proprietary system? This is all a little confusing (or maybe I'm overthinking!). Are they interchangeable? Thanks.

 

[Adrienne]

Hi Selma. If I am not mistaken, Heartport is a minimally invasive system going through the right side between the ribs, but is NOT robotic surgery. The da Vinci robot is robotic surgery, and from what I have heard is supposed to be the best minimally invasive technique because apparently, the surgeon who sits in front of a screen and moves around the virtual scalpel, must move a full centimetre for every millimetre that the actual scalpel moves inside the patient. That prevents him from slightly jerking his hand and making a mistake in that way. There may be people who know even much more about this than I do, but this is what I have read.

 

[Luana]

Adrienne is right; daVinci is the robotically-assisted surgery and heartport, from what I see on their Web site, is a mini-thoracotomy, which was how I had my AVR. I remember the consent form for surgery said "port access" on it.

My incision was about 3 inches, on the right side of my chest, about 3 inches down from my collar bone. I specifically asked for it as I did not want to have my sternum broken. I'm glad I did ask for it. I had little pain after surgery, was able to drive after 2 weeks, and did not have the shoulder, back and "run over by a truck" pains that everyone seems to complain about after sternotomy. I wanted this approach because I live alone and wanted to be as independent as soon as I could after surgery.

I have nothing bad to say about it. I am surprised more do not have surgery this way.

 

[rubywhistle]

Hi this sounds a bit like mine maybe- i had a right side ribs incision

 

[Lynlw]

Adrienne is right; daVinci is the robotically-assisted surgery and heartport, from what I see on their Web site, is a mini-thoracotomy, which was how I had my AVR. I remember the consent form for surgery said "port access" on it.

My incision was about 3 inches, on the right side of my chest, about 3 inches down from my collar bone. I specifically asked for it as I did not want to have my sternum broken. I'm glad I did ask for it. I had little pain after surgery, was able to drive after 2 weeks, and did not have the shoulder, back and "run over by a truck" pains that everyone seems to complain about after sternotomy. I wanted this approach because I live alone and wanted to be as independent as soon as I could after surgery.

I have nothing bad to say about it. I am surprised more do not have surgery this way.

Luana, Did you have the extra incision in either your groin or shoulder/neck area for the heart/lung machine? I Think the heartport system, was/is a way to not need the extra incision to hook up for bypass, they just ran a cath up from the groin to the aorta. I think they had problems with it, so not sure how that system works now.

They probably put port in the name since port access is kind of a general term for surgeries done with a couple small incions (Laparoscopic) and not a large surgery, kind of like gallbladder surgery gastric bypass etc

 

[offwego]

I had heartport minimally invasive MV repair 8 years ago... I found the recovery to be painful, the scar is smaller. My repair needed to be redone 4 weeks ago and this time the surgeon did the full cut for better access and was able to repair it again. I am scheduled to see him tomorrow and will find out why the first repair didn't hold up and if the minimally invasive approach had anything to do with it.

From what I've heard from several people is that there are more nerves in the rib area and while the incision is smaller there can be more pain. Not everyone agrees.

I've posted my thoughts about this recently, and you might want to search around and read other opinions as well.

Good luck with whatever you do and welcome aboard.

 

[selma]

Offwego, I did read your other post about your minimally invasive surgery....hadn't realized it was heartport. I'm sort of waffling about the whole thing (I'm sure we all do). It's still premature, as I don't even know if I'm a candidate, but I wanted to get a handle on the differences.

Thanks to all for the insight.

 

[Lynlw]

I had heartport minimally invasive MV repair 8 years ago... I found the recovery to be painful, the scar is smaller. My repair needed to be redone 4 weeks ago and this time the surgeon did the full cut for better access and was able to repair it again. I am scheduled to see him tomorrow and will find out why the first repair didn't hold up and if the minimally invasive approach had anything to do with it.

From what I've heard from several people is that there are more nerves in the rib area and while the incision is smaller there can be more pain. Not everyone agrees.

I've posted my thoughts about this recently, and you might want to search around and read other opinions as well.

Good luck with whatever you do and welcome aboard.

Justin had one of his heart surgeries done between the ribs, but he was a baby so couldnt say if one way hurt more than the other, but I think beside the nerves another reason why some say that incision is painful is because they cut thru muscles too. That kind of makes sense to me since Justin's had a few heart surgeries since he was old enough to remember, and for HIM at least he always said the actual sternum wasn't terribly painful, but sore and uncomfortable. Then last sugery he neded another surgery where they reopened him, and had to move some muscles that hurt more than his sternum. At the time one of the surgeons said it kind of was like when you hear of athletes tearing a muscle and that being painful, but insted of tearing it they cut and moved it.

Its good to hear from someone that has had both

 

[offwego]

Justin had one of his heart surgeries done between the ribs, but he was a baby so couldnt say if one way hurt more than the other, but I think beside the nerves another reason why some say that incision is painful is because they cut thru muscles too. That kind of makes sense to me since Justin's had a few heart surgeries since he was old enough to remember, and for HIM at least he always said the actual sternum wasn't terribly painful, but sore and uncomfortable. Then last sugery he neded another surgery where they reopened him, and had to move some muscles that hurt more than his sternum. At the time one of the surgeons said it kind of was like when you hear of athletes tearing a muscle and that being painful, but insted of tearing it they cut and moved it.

Its good to hear from someone that has had both

I'll ask the source this question tomorrow...Dr. Aubrey Galloway of NYU...can't get much of a better person to ask. I have a few questions for him...I want his opinion of the fact my first MV surgery was in my opinion a 'failure' (i doubt he agrees) but I will ask directly if there would have possibly been a better outcome with a full cut surgery. I doubt he says yes but this is the guy to ask.. He's even better than google...lol...i hate wasting a minute of his time to be honest. But I do have a few questions and frankly while I love the guy..I hope this is my last appointment with him EVER...cause there's no reason to be seeing him unless to talk about surgery. I'd love to not need this done AGAIN.

 

[Luana]

Luana, Did you have the extra incision in either your groin or shoulder/neck area for the heart/lung machine? I Think the heartport system, was/is a way to not need the extra incision to hook up for bypass, they just ran a cath up from the groin to the aorta. I think they had problems with it, so not sure how that system works now.

From what I've heard from several people is that there are more nerves in the rib area and while the incision is smaller there can be more pain. Not everyone agrees.

Lyn, heat/lung machine connection was done in left groin (right was used for cath a couple weeks earlier), and I wouldn't really call it an incision, as it was one stitch each for artery and vein, so not much of a cut at all.

Off, not only are there more nerves in the incision between ribs, but there's more muscle, and, it's my understanding that cutting through muscle is more painful than cutting in areas where there is little or none, such as the sternum. For me, it did not feel painful in the hospital. When I got home and was using my right arm a bit more (thought not doing anything heavy), it did feel more sore sometimes, but I still can't call it painful.

Years ago I had surgery in my lower back for a herniated disc, quite a bit of muscle to cut through there, and I did not think pain was bad at all; it felt more sore than painful. After seeing the herniated disc, the surgeon told me I must have a high tolerance for pain, as it was quite bad.

I've thought of myself as kind of a wuss when it comes to pain, but maybe I'm not.

 

[offwego]

As promised, I had an appointment with Dr. Aubrey Galloway @ NYU. He is head of Thoracic Surgery and I think he is just a bit more qualified than me in which surgery is 'best'..

I told him about this thread and that I was asking him for his response and would not mention him, if he didn't want me to. He had no problem being on record.

Here's what he said. "First surgery valve patients, I almost always do minimally invasive surgery. There is less blood loss and we track results carefully and when compared to results from traditional surgery over a 10 year periods the results are identical."

So for all of my personal experience and commentary how much more painful minimally invasive surgery is, I would simply follow his advice and if I had a choice, I'd still go for minimally invasive surgery.

BUT, the pain was so much worse...and Luana maybe you have a higher pain tolerance as you said, than you think.

He does not often (or ever..I was unclear) do second or third surgeries via minimally invasive approach. I didn't ask him if in retrospect if he could have repaired my Mitral Valve if he had in fact done Minimally invasive...it just seemed like a stupid question.

 

[bvdr]

I too had the Heartport surgery through my right chest wall and through the lower portion of my right breast. I did end up with scar tissue in my right lung (they deflate it and move it out of the way for surgery) and I had a lot of problems with muscle spasms in my right chest for the first couple of weeks post-op. I had it done at Duke in 8/03. It seems to have done the job.

 

[Luana]

I too had the Heartport surgery through my right chest wall and through the lower portion of my right breast.

I guess we're part of the small few here who've had this route. My right lung collapsed the day after surgery, not sure if it's related to the approach or not, as it's not a real uncommon thing to happen after VR.