Minimally invasive mitral valve replacement

[vv7814]

Has anyone undergone Mitral valve and Aortic valve replacement with minimally invasive surgery, not open heart. Would appreciate your feedback. Where was it done if you had it done?

 

[pellicle]

Hi and welcome.

I haven't had minimally invasive surgery (some here have) but you have to ask yourself why you're interested in it.

If the answer is that you're freaked out about having the surgical wound then put aside that and stop focusing on what you really don't know much about (the surgery) and return your attention to what's within your control (which is proper recovery and any decisions you are asked to make about valve).

Make your decisions strongly biased on actual scientific data, not what some shill website says (hello Adam Pick) who makes a living being an infotainer and shills products for valve makers and clinics and surgeons.

I would strongly caution about seeking out someone who does that specific thing (like minimal invasive) and instead seek out:

1. a good history of no post surgical complications
2. a good hospital with a well regarded post surgical care and very low post surgical infection rates
3. somewhere conveniently located because trust me, you don't want to be travelling far

Best Wishes

PS: I just looked at your BIO to see if you'd put in your age, saw you read Adam's book LOL'd ... I recommend you put that primary school level (metaphor) stuff down now and start on with middle and highschool level education for your reading

bPeer Reviewed Journal is what you want to be reading (not fluff)
Its harder reading but ...

 

[pellicle]

a good start (if you've not already read it)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191712/

Conclusions​

Minimally invasive surgical approaches to aortic and mitral valve repair and replacement offer reduced post-operative pain, a faster return to baseline activity and at least equivalent morbidity and mortality as traditional valve operations. In addition, surgical techniques allow for the removal of existing valve tissue and debris, which may improve paravalvular leak rates. While minimally invasive aortic and mitral valve replacement currently require longer CBP and aortic cross-clamp times, the development of sutureless aortic and mitral valves may reduce these times and further improve outcomes. Minimally invasive techniques should be considered in many patients requiring isolated valve repair or replacement.​

1 "at least" ... maybe better would be better than "may be as good as" ... after all morbidity (IE you are sicker in some ways now) and mortality (you died) are important.
2 cross clamp means higher predictor of mortality and morbidity because your blood is being circulated by machine not your heart. Don't underestimate this as it is responsible for post-perfusion syndrome.
I've underlined and bolded and marked what I think is important to read.
3 "which patients and why"

 

[vv7814]

Hi and welcome.

I haven't had minimally invasive surgery (some here have) but you have to ask yourself why you're interested in it.

If the answer is that you're freaked out about having the surgical wound then put aside that and stop focusing on what you really don't know much about (the surgery) and return your attention to what's within your control (which is proper recovery and any decisions you are asked to make about valve).

Make your decisions strongly biased on actual scientific data, not what some shill website says (hello Adam Pick) who makes a living being an infotainer and shills products for valve makers and clinics and surgeons.

I would strongly caution about seeking out someone who does that specific thing (like minimal invasive) and instead seek out:

1. a good history of no post surgical complications
2. a good hospital with a well regarded post surgical care and very low post surgical infection rates
3. somewhere conveniently located because trust me, you don't want to be travelling far

Best Wishes

PS: I just looked at your BIO to see if you'd put in your age, saw you read Adam's book LOL'd ... I recommend you put that primary school level (metaphor) stuff down now and start on with middle and highschool level education for your reading

bPeer Reviewed Journal is what you want to be reading (not fluff)
Its harder reading but ...

View attachment 888946

 

[vv7814]

Thank you for your feedback. Not worried about scars, but risks and recovery. I just found out about the mitral valve and aortic valve stenosis through the echo and the surgeon recommended open heart surgery. I am not sure which way or where to go. I am getting a second opinion today. Hopefully that will be helpful.

 

[pellicle]

I just found out about the mitral valve and aortic valve stenosis through the echo and the surgeon recommended open heart surgery. I am not sure which way or where to go. I am getting a second opinion today. Hopefully that will be helpful.

second opinion is good.

I'll throw in mine: the open heart operation for Aortic Valve replacement is the gold standard to which others are compared. So much so its often abbreviated to SAVR
So, as a metaphor: If you work on cars or motorcycles you'll often find that if you'd taken the bonnet off the car (you probably call it The Hood) you'll get better access and save yourself more time and be able to to the job better than if you tried to work in a cramped space. You may also spot things you otherwise may have missed.

So to my understanding (and I've had 3 OHS for Aortic so far all of them standard) minimally invasive isn't available for two valves.

I'd also advise you to ask about Lp(a) (see here) and ask to get that tested, because to have two valves calcify (the primary cause in stenosis) is not usual (unless you had Scarlet Fever as a younger man). Perhaps @Chuck C may have time out from his christmas madness to offer a word about that.

How old are you? (yes, it matters to some aspects of this if you are 28 or 78)

 

[BIG DAWG]

Has anyone undergone Mitral valve and Aortic valve replacement with minimally invasive surgery, not open heart. Would appreciate your feedback. Where was it done if you had it done?

I had Mitral valve replacement with minimally invasive surgery on September 22nd, 2022, at Grandview Medical center Birmingham AL by Doctor John Richardson.

 

[catwoman]

Has anyone undergone Mitral valve and Aortic valve replacement with minimally invasive surgery, not open heart. Would appreciate your feedback. Where was it done if you had it done?

I had MVR (St. Jude mechanical) 19 1/2 years ago. No problem with warfarin and I home-test. My native valve failed due to myxomatous tissue (degeneration).
My cardiologist is now monitoring my aortic valve and has mentioned TAVR. However, I have read that TAVR is not a long-lasting answer to valve replacement. I will see my cardiologist Jan. 10 and will certainly ask him about that. Who wants to go back in every 5-7 years? And I don't know how many times it can be repeated. I am now 72 and could live at least another 18-22 years, based on parents' and grandmothers' lifespans.

 

[Aquila]

Has anyone undergone Mitral valve and Aortic valve replacement with minimally invasive surgery, not open heart. Would appreciate your feedback. Where was it done if you had it done?

I had minimally invasive aortic valve replacement via right anterior mini thoracotomy at UAB Hospital (University of Alabama in Birmingham) by Dr. Clifton Lewis in October 2019.

 

[Uni&Suki]

Hi, I underwent aortic valve replacement (St.Jude) via minithoracotomy at the University of Iowa Hospital (Iowa City) 4 weeks ago. I chose this surgery because it is less invasive than open heart surgery and the post-operative course is somehow, smoother with less pain. My surgeon, Dr. Bashir, did specific training in this type of surgery and he has been doing it for at least 5 years now! The surgery took 3:30 hours, which puts you on a shorter time on the bypass machine! I stayed at the hospital for 5 days (including the operation day) and my main complaint was pain due to chest tubes (it was really that bad for me), otherwise, I didn't have any complications. The only thing that I was not informed about, maybe I didn't do enough research prior to surgery, is the numbness around the incision site. For me, it is slowly improving but I am not sure if it will completely vanish or not. Please let me know if you have any questions!

 

[AZATADINE]

@pellicle is that Adam Pick site really that bad? I've never found it easy to navigate as an interactive forum. Never really got to grips with the site but interesting to hear that it's a bit of a shill. That's poor, considering he's had valve surgery himself.

 

[Chuck C]

Hi and welcome to the forum.

By minimally invasive, do you mean a smaller surgical opening, compared to a full sternotomy, or are you referring to TAVI aka TAVR, which uses transcatheter?

I had a minimally invasive surgery, via a procedure known as a mini-sternotomy, at UCLA, with Dr. Richard Shemin. Of the minimally invasive procedures practiced, this is probaby the closest to getting a full sternotomy, as it opens up the top half of the sternom with a 3 1/2 inch opening. It was the procedure preferred by my surgeon and recommended by him. He's completed thousands of them and has excellent survival statistics to show for it, something which I paid close attention to in choosing a surgical team.

I think that there are pros and cons to going minimally invasive. It means quicker healing, generally, but as others will often point out, sometimes it is better to "open up the hood completely", to get better access. If I had it to do over, I am not sure which way I would go. I was able to get back to normal relatively quickly, probably faster than if I had a full sternotomy, but the recovery time is really just a blip in the grand scheme of things. From what data I've seen, there does not appear to be any mortality advantage either way. In an interview I watched online with Dr. Doug Johnson and Dr. Lars Svensson of the Cleveland Clinic, this was a point made by them as well, that there was no survival benefit, but there is demand for the procedure from patients, to get back to things quicker.

Replacing both mitral and aortic valves is a more complicated surgery, compared to just doing one valve. I would think that it would tilt the scales towards doing a full sternotomy, for better access. In fact, I have never heard of a minimally invasive procedure for replacing both valves at once, so it may not even be an option for you. You might check in with Cleveland Clinic. If such a procedure exists for both valves at once, they will likely be one of the few clinics doing them.

Pellicle mentioned Lp(a). Have you had your Lp(a) level tested? It is a lipoprotein, which is estimated to be the cause of about 1/7 of all aortic stenosis cases, yet, it is most often overlooked, even by cardiologists. It is a simple blood test and can be run as a stand alone test with Quest Diagnostics or Lapcorp, or if you get an advanced lipid panel at Quest, known as a CardioIQ, it will include Lp(a).

Also, good that you are getting a second opinion. That is always a good idea.

 

[pellicle]

is that Adam Pick site really that bad?

he has no formal qualifications, started off knowing nothing about medical things (education not in physiology or biology). Strongly opinionated seldom quotes peer reviewed data. Predominately showcases surgeons and advocates techniques he really knows nothing about.
I believe he began to "inform himself" (aka seek justifications for his biases) as a part of his role.

He's about as good as morning TV if you ask me.

Few people in my experience can actually grapple with knowing and understanding. Reading comprehension seems worse than abysmal in so many cases. If you haven't done any study (meaning at a university level where expectations are actually higher) about critical thinking then you probably don't have the capacity to read properly anyway.

I have posted this before, I recommend spending about the same time as a student at a university would spend on understanding it and honing it in practice. In my experience at such places it takes most people on average a year to get to that place. Some never do.


https://www.uow.edu.au/student/learning-co-op/assessments/critical-analysis/

This may seem harsh, but so are the reality of outcomes for deluded decision making.

¯\_(ツ)_/¯

Best Wishes

 

[QuincyRunner]

Speaking of reading, the U.S. Dept. of Education just reported that 54% of American adults read below the 6th grade level. I hate to think what the comprehension rate is. (And don’t tell the Chinese).

 

[carolinemc]

Hi, I underwent aortic valve replacement (St.Jude) via minithoracotomy at the University of Iowa Hospital (Iowa City) 4 weeks ago. I chose this surgery because it is less invasive than open heart surgery and the post-operative course is somehow, smoother with less pain. My surgeon, Dr. Bashir, did specific training in this type of surgery and he has been doing it for at least 5 years now! The surgery took 3:30 hours, which puts you on a shorter time on the bypass machine! I stayed at the hospital for 5 days (including the operation day) and my main complaint was pain due to chest tubes (it was really that bad for me), otherwise, I didn't have any complications. The only thing that I was not informed about, maybe I didn't do enough research prior to surgery, is the numbness around the incision site. For me, it is slowly improving but I am not sure if it will completely vanish or not. Please let me know if you have any questions!

What happens to the chest muscles is the stretching and trauma. It will be sore, from time to time, till it is completely healed, in a year's time. Tubes are only temp, and you will be healed from them soon. Just relax and let the body heal itself. And glad you were on less time on the pump (the heart and lung machine).

 

[pellicle]

(And don’t tell the Chinese).

having spent an amount of time in Japan, Korea and a lesser extent China, and all I can say is that each place has its own standards of what "literacy" means and what amount of vocab is needed. Just so that I get an angry face on this I'll say China has the lowest.

 

[lilyofthewest]

QuincyRunner: "Speaking of reading, the U.S. Dept. of Education just reported that 54% of American adults read below the 6th grade level. I hate to think what the comprehension rate is. (And don’t tell the Chinese)."

Sorry if this is taking the thread further off topic but this is not and unusual statistic. I taught reading for 40 years, until 2010. We looked at this often and yes it's been true for a long time that adult literacy in the US hovers around 6th grade level. And the average adult reads less than 2 books a year. So maybe people should be less critical of kid's reading test results. You get what you model.

The most literate place, at least when I left teaching, was Australia/New Zealand. In the US, least literate state....Mississippi. Highest literacy and rate of books sold...San Francisco.

 

[vv7814]

Thank you for all your advice. I have scheduled open heart surgery for Jan. 20 to replace both Mitral and Aortic valves at the University of Chicago Medical Center. Hopefully everything goes well.

 

[ValveAdmin]

Thank you for all your advice. I have scheduled open heart surgery for Jan. 20 to replace both Mitral and Aortic valves at the University of Chicago Medical Center. Hopefully everything goes well.

I wish everything goes well!

 

[pellicle]

Hopefully everything goes well.

wishing you a text book procedure and uneventful recovery.