How many have had minimally invasive AVR?

[almost_hectic]

Forgive me for asking but I haven't met with surgeon yet, but how much quicker is recovery? What can I expect? How many weeks compared to the regular surgery?

 

[Paleowoman]

Hi - it all depends and there doesn't appear to be any hard and fast rule as regards recovery. I was meant to have minimally invasive surgery as that's how it's normally done for isolated aortic valve replacement in the UK. Not that I would have minded either way as I only wanted the best access for the surgeon. The usual length of a minimally invasive incision is 2 to 3 inches. My incision was longer, around 4 1/2 inches, because the surgeon found she couldn't access my aortic valve with the "mini-sternotomy". The incision I ended up having is still not a full sternotomy but about three quarters the length of my sternum. My recovery seemed the same as people who have a full sternotomy...but I stress that recovery is surely an individual thing, depends a lot on your anatomy and how easy or difficult it is for the surgeon to access the aortic valve whichever way he/she goes in.

There is another minimally invasive technique which goes between the ribs and doesn't touch the sternum at all. I should imagine, though I don't know, but that would be a quicker recovery as the sternum is not cut.

Bonbet recently started a thread about minimally invasive surgery here which would probably interest you: http://www.valvereplacement.org/foru...-this-incision

 

[almost_hectic]

Not positive yet, but I think the method my surgeon will use is the one you describe as between the ribs. I think it's called LIV or least invasive valve. Hoping to find others who have had that procedure who can describe their recovery

 

[Harley2000]

I had the "between the ribs" surgery in August of 2012.
I had a mechanical aortic valve installed and a mitral valve repaired through a 6 inch incision.
I was told that the hospital stay would be the same as with a sternum mini or full incision.
Once I was home after 5 days in hospital, the recovery was fast and fairly easy. No discomfort at all as far as the incision.
It was hard not to keep from overdoing it after a few weeks at home. I was riding the Harley a month after the surgery.
The incision scar is just a thin white line that is hard to see. There is a small area around a portion of the incision that "feels funny" probably because a nerve was cut but is not problem.
I am glad my surgeon was experienced and capable to do this procedure.

 

[knotguilty]

I had the mini AVR. They went in between my ribs in my upper right chest. About a 5 inch scar. Recovery for me was fast, but I would still recommend taking your time to heal and recover.

 

[almost_hectic]

I had the mini AVR. They went in between my ribs in my upper right chest. About a 5 inch scar. Recovery for me was fast, but I would still recommend taking your time to heal and recover.

Yes of course, good advice. Will take time. Just trying to understand how long I might miss work and such. How long or how much rehab is typical with this procedure?

 

[knotguilty]

I took the entire 12 weeks out from work and did my rehab. Rehab about 3 days a week. By the end of the 12 weeks I was jogging on a treadmill. I ran a 5k shortly after that. But two weeks after surgery I did a break job on my sons car. I could have went back to work after a couple weeks. I did have an episode early in the rehab and almost passed out from the meds I was on. They took me off the BP med that I really didn't need after that. So I would take the time to make sure everything is agreeing with you, meds wise and health wise before you get too busy.

 

[almost_hectic]

Wow, aside from smoothing out your meds, your recovery sounds like it went fantastic! Yeah it didnt sit well initially at my office that I had to be out for so long but I think they get it now. I guess it means Im irreplaceable.

 

[almost_hectic]

Met my surgeon Dr. Paul Digiorgi in Fort Myers, FL yesterday. Very impressed with his knowledge and approach to care, his whole team for that matter. He confirmed he will be doing my AVR through a minimally invasive technique with a short incision between the ribs. Said the surgery itself takes about two hours, and that they would likely have me up and walking around later that same day. Out of the hospital two days later, so three days hospital stay in total. I was also pleased he wishes to use the latest ON-X mechanical valve as my replacement. Said I would have a nurse make visits to my home over the 2 weeks following and then after a follow up visit to his office I would be mostly recovered but at that point they would turn me back over to my cardiologist for care and to manage any cardiac rehab. He made it sound so easy. Dont get me wrong he explained it is a very complex procedure and that its no walk in the park, but he does it every day and he believes I should have a fantastic recovery. His level of confidence and attention to detail is very reassuring. Big day in 3 weeks. I go back and forth from being very scared to actually looking forward to it all.

 

[Bonbet]

Hectic, I am wondering if they shared with you any of your numbers, like valve area or AVA, max velocity, mean gradient, and whether or not you have LVH (Left Ventricular Hypertrophy?) are you symptomatic? I am curious because of the disparity of opinions you received. My situation is similar, heart is good and no arterial disease or BP issues. But they say the valve is very bad. I've heard " do it now" as well as " you've got a year at least" from very reputable cardios and surgeons. I have compared my numbers to the gold standard (ACC/AHA) guidelines for intervention and am trying to discern the extent that surgeons use them. Mostly because I am reluctant to have the surgery if I have not reached the threshold. Any numbers? Anybody?
Bonbet

 

[R1Phrankey]

I have had a mini AVR. A 3 inch cut in the sternum. My ribs on the right side hurted a lot after surgery. Took me more than 9 months before I was completely out of pain and I sometimes still feel a sternum pain. I guess the surgeon had to really force my sternum open to get good access to the aortic valve.

 

[almost_hectic]

Bonbet, The only numbers I recall hearing where the gradient. At my last echo they said my gradient was 85. Its my understanding that 45 is considered severe. Cardio then performed a cath and said the gradient they were able to measure then was more like 50, but that the valve looked in really bad shape, very calcified and barely opening and closing. They said I could wait but did not recommend more than 6 months. I have no symptoms, at least I dont feel weak or lightheaded. I do get tired easily, but I dont think I even realized that until I started to be more mindful of it. Otherwise I am in excellent health, all my arteries are clear and healthy. An excellent picute of health is another argument for doing the surgery now. The healthier you are they better your recovery will be. Im not interested in waiting. Ive waited for 15 years already. Im looking forward to being on the other side of this. Even as scary as surgery sounds. I know I cannot avoid it. The closer you get to the threshold or "standard", the more at risk you are for dying from sudden cardiac arrest. And that to me is far scarier than any surgery! Not to alram you but it scares the hell out of me to think had I not switched cardiologists, I could come too close to missing out on surgery. I say this because I knew someone when I was young who needed valve surgery and delayed it out of fear. He never made it to surgery. Im confident in the surgeon I have and trust his suggestion to go forward.

Phrankey, thankfully it sounds as though my sternum should remain untouched. Surgeon confirmed he's 99 percent sure he will go between the space of 2 ribs. Headed to hospital shortly for my CT scan and chest xrays that he will use to confirm what technique he wishes to use. Fingers crossed! But ingeneral I feel very good about what to expect.

 

[almost_hectic]

Bonbet, The only numbers I recall hearing where the gradient. At my last echo they said my gradient was 85. Its my understanding that 45 is considered severe. Cardio then performed a cath and said the gradient they were able to measure then was more like 50, but that the valve looked in really bad shape, very calcified and barely opening and closing. They said I could wait but did not recommend more than 6 months. I have no symptoms, at least I dont feel weak or lightheaded. I do get tired easily, but I dont think I even realized that until I started to be more mindful of it. Otherwise I am in excellent health, all my arteries are clear and healthy. An excellent picute of health is another argument for doing the surgery now. The healthier you are they better your recovery will be. Im not interested in waiting. Ive waited for 15 years already. Im looking forward to being on the other side of this. Even as scary as surgery sounds. I know I cannot avoid it. The closer you get to the threshold or "standard", the more at risk you are for dying from sudden cardiac arrest. And that to me is far scarier than any surgery! Not to alram you but it scares the hell out of me to think had I not switched cardiologists, I could come too close to missing out on surgery. I say this because I knew someone when I was young who needed valve surgery and delayed it out of fear. He never made it to surgery. Im confident in the surgeon I have and trust his suggestion to go forward.

Phrankey, thankfully it sounds as though my sternum should remain untouched. Surgeon confirmed he's 99 percent sure he will go between the space of 2 ribs. Headed to hospital shortly for my CT scan and chest xrays that he will use to confirm what technique he wishes to use. Fingers crossed! But ingeneral I feel very good about what to expect.

 

[soccer girl]

Hi almost_hectic,

I also just had the minimally invasive technique between the ribs that you describe in April 2015 for AVR - and had the ON-X mechanical valve. I was released from hospital on day 4 and only have a 2.5 inch scar in upper right chest. Personally I have had an amazing recovery - everyone is amazed at how well I am doing - I went back to work last week. I was an active person prior to surgery and very very non-symptomatic (soccer player - half marathon runner - skier) . It was hard to believe the numbers indicating that my heart was in such bad shape. Currently I am actually more active now than before surgery and it has only been 3 months and 10days. Currently I bike 25km, swim 1km, walk/run up to 10km (planning to be back running without the walks by fall) at a time. I also did a 21km hike up to a lookout in 30C weather. I am officially more fit than I have been in a few years. You should be very happy that this option is being offered - I do not believe it is done at all centers yet. I did take the full time off work (12 weeks) mostly to ensure that I had time for all the recovery and rehab required. This also gave me the time to take the rehab slow but steady which really does win the race. It is important not to overdo things -especially with this surgery since you aren't in a lot of pain.

One thing that surprised me about this technique is the fact that to get enough room and access to do the surgery - my surgeon makes the incision and then dislocates one rib out of the way. To replace this rib I now have two titanium plates and ten screws holding everything in place. I am not clear if all surgeons doiing this technique do this or not? I still have a bit of discomfort from the plate and screws - but it is wayyyy better than the other option of the full sternectomy.

Good luck to you - sounds like you are in great hands !

 

[MrsBray]

I had a full sternotomy 3/5/2014, home on 3/9. I drove my car on 4/4 at one month post op, and started cardiac rehab 5 weeks post op. If I had an inactive job (at a desk or minimal walking) I feel i could have gone back to work at 5 weeks. I work in a warehouse and drive a bus, so I was out for a mandatory 12 weeks. I can't feel any wires or screws. My surgeon and I discussed the minimally invasive option (which is not to be confused with the TAVR!) and I made the decision to go with the full sternotomy just in case he needed more room once he got in there and found something else. My scar barely peeps above a scoop neck shirt, and is almost completely flat 16 months post op..
Definitely ask how you are going to be patched back together. I'm not sure how my sternum is put together (I can't feel anything other than my bone). I could call to ask teh surgeon's office, but I don't really care.
-Meredith