HeartDoc, it's great for many of us to have you here, including this pre-op BAV newbie. I've perused your web-site, and quizzed my surgeon about it. He's at Toronto General Hospital, in the department headed by the well-known Dr. Tyrone David. He said they do some minimally invasive surgeries, but only under pressure and then they usually feel stressed while doing it. You've mentioned the "practice" and "comfort" issues, and they're obviously important in any surgery, and especially so in major surgery like OHS.
Personally, I've spent the last 10-odd months thinking and blogging about an unrelated medical condition -- Achilles Tendon Ruptures! As "normofthenorth" at achillesblog.com , I worked hard (and with some success) to introduce fellow ATR patients to the recent studies that produced excellent results WITH or WITHOUT surgery, provided a modern (fast) rehab protocol was used. Many patients who read my stuff became "difficult" patients for Ortho Surgeons who were doing the same ol' same ol' ATR repair surgery on everybody -- and then often keeping them on crutches and immobilized much longer than the new evidence suggests works best! Some of my readers were quick enough to skip the surgery completely, while others got the op but speeded up their rehab protocols, and/or recovered in a boot instead of a cast, and otherwise improved their rehab while challenging their health professionals. (Thank Heavens, everybody who changed their treatment while thanking me for the advice has recovered very well! I'm not a Doctor, and my wife was afraid I was going to get sued if somebody turned out badly -- which is ALWAYS a risk!)
I didn't mind making all those doctors uncomfortable in the LEAST, in return for getting those patients onto a recovery path that had better odds AND was quicker and more convenient.
I haven't totally wrapped my head around the applicability of your M.I. surgeries to my specific situation -- facing an AVR, Aortic root replacement with Dacron, and maybe a MV repair or even replacement -- but I'm finding that my attitude has subtly changed with my migration from achillesblog.com to VR.org! My general choice of surgery now reminds me a lot of the choices I influenced at AB.com, but I'm now VERY concerned with keeping my surgeon and his team in their Comfort Zone!
I'm not the kind of person to just "go with the flow" or to place my fate in the hands of an Expert, or even God, without first checking out the details. But when facing the prospect of having somebody holding my heart in their hands (with a scalpel in their OTHER hand!), I find myself more tempted to go along with a local, well respected, highly practiced, "Good Enough" process that seems to produce low-risk quality repairs -- even if it means that I'll be worried about my sternum knitting back together for months instead of days or weeks, and vulnerable to injuries etc. for maybe longer than necessary.
I'm finding it very interesting to "get in touch with" my preferences on this decision. Of course, decisions about the type of surgery, and the kind of replacement valve, etc., ultimately HAVE to be made by the patient, via informed consent. Many people (and websites and books, etc.) can play the role of adviser to make that informed consent more informed -- and the medical team ultimately has to be willing to DO what the patient WANTS. But when it came to the decision to have ATR repair surgery or skip it -- after FOUR recent randomized trials, all since 2007 have pretty consistently shown identical results except for the surgical complications -- I would have pushed my friends and relatives pretty hard to get them to skip the surgery. "It's your decision, but so is jumping off a bridge" type thing. Some choices are smarter than others!
Your approach to minimally invasive heart surgery -- on your own website and here -- seems very familiar to me, because it reminds me of my approach to the choice of "op vs. non-op" for ATR treatment, and the choice of modern fast rehab protocols vs. old-fashioned slow protocols. So I consider you a "breath of fresh air" and a "kindred spirit" in your attitude, your preferences, and your willingness to speak frankly and bluntly in favor of the choices you see as best for the patient. Who knows, if I lived in NYC, I might even ask you to take on my surgery. (Or not! My hesitation is personally fascinating to me. Hope it's not boring to everybody else!)
Sorry to ramble on, but facing this surgery has made me think of things in ways I don't often do. If nothing else, the experience has made me more understanding of the people who read the Achilles evidence I presented on that other website, and STILL just went along with their Doc's surgical plans, or his old-fashioned slow rehab protocol -- or both!
