Minimally Invasive Post Op

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Kandice

I would like to clear up some misconceptions about this procedure, I have talked to 3 heart surgeon and yesterday to my cardiologist. So here is their opinions and caveats. Oh and also the pre op nurse that helps patients with questions and what to expect.

I 've had numerous well intentioned people tell me I am lucky to have the minimally invasive approach because its less painful and easier.


Some of this information is correct but some is wrong.


My husband and I ( he is a orthopedic surgeion) first met with the cardiac surgeon in Portland OR, Dr Oakies very well respected and an excellent cardiac surgeion. He informed us after I stated I was interested in the minimally invasive procedure . He stated He did not do that procedure but felt it definitely has benefits. His caveat was it is a more painful procedure. We thought he must have been mistaken because we thought it was suppose to be easier.

So the benefit according to him was
1. less possiblity of developing cardiac arrythymias such as atrial fib, due to the way the heart is accessed and SA node ( controls heart beat and rhythym) is less traumatized.

2. Some other technical things also which benifit the heart.can't remember
3. Better overall recovery maybe faster, but still have the same fatigue and energy issues.
4. Cosmetically you can't see the scar when recovered.

You can't have this approach if you need a cardiac bypass, so you are screened with an angiogram for coronary heart disease.

My 3rd day post op we had a conversation with the cardiac fellow that works with Dr Patracek I was concerned because I had gotten out of control with my pain the day before and was continuing to have trouble with pain management. He explained that the minimally invasive or he called it a thoracotomy is one of the most painful surgeries people can have. The reason being is they have to go through muscle and nerves and spread the ribs. He stated that the traditional sternotomy is still painful but because the bone is so close to the skin there isn't muscle or major nerves to go through. That made me feel better because I started thinking something was wrong.

Yesterday I talked to my cardiologist and she also stated that some surgeons elect not to do the minimally invasive due to pain management. She stated people hear the word "minimal" and assume that it is easier.

After all this I still recommend the procedure because there are real medical benefits, although I think everyone is different and we should make this decision with a trusted doctor.
I think in the long run that I may heal faster than the sternotomy,

Discharge instrctions per Dr. Patracek:

1. Walk everyday!!
2. Take it easy for 12 weeks
3. No lifting for 8 weeks !!!!
4. No driving for 8 weeks
5. Monitor BP twice daily, take temperature daily
6. Keep BP systolic under about 130 with exercise.

I hope this clears up and helps those who choose this procedure , not to scare peoplet but to give the real information.
Kandice
 
Kandice,
Dick also had minimally invasive and his cardiologist explained to him re-surgery that it was like getting hit by a mac truck instead of a 16 wheeler. Unlike you, Dick never did have any pain from the incision. His only pain was in the shoulders from the way they lay you out in all open heart surgeries. Also, he did have one day of afib two days out from surgery which was controlled at first with an IV and then oral medication.
 
Kandace,
I experienced little to no pain when I had the port access minimally invasive mitral valve repair this last February. I am aware of 3 other people who had the same procedure with the same surgeon and experienced the same or similar results. I wonder if it is his team of anesthesiologists this can be attributed to. The anesthiologist who managed my surgery gave me a nerve block around the incision, and I had a pain pump on the side of the incision after the surgery. Plus of course the usual morphine pump and other pain medicine. (Gee, that sounds like a bunch of stuff, doesn't it? :) )
 
Agree. If you search this site for "right thorocotomy" you'll see my experiences.

I always thought that "minimally invasive" was only for the port access but what do I know. It is nice to not have the sternum cut but I went into knowing full well (thankfully) that it would be more painful in the short term. Kinda feels like a major leaguer mistook your ribcage for the strike zone.

That aside, I'd do it over the same way in a heartbeat. My surgeon described the crossover point at about 8 weeks when the rib incision becomes less painful than a sternotomy. Never having had the other approach what do I know but I was off pain meds within a couple of weeks and have no trouble now. The cosmetic benefit to me was what I was seeking and the scar is not noticeable at all. Day 1 was the worst pain-wise but geez, isn't it that way for everyone?

Oh, and ladies if you choose this approach you may never wear an underwire bra again. Victoria's Secret has some nice alternatives that work just as well w/out those pesky wires. Sorry guys if that's more than you wanted to know.

Sorry Kandice that you didn't get clear guidance going in, that's not a nice surprise to get.

Hmmm, dunno about the arrhythmias, guess I ended up on the short end of the statistical stick on that one, I had a pesky post-op a-fib for 2 months.....

Peace,
Ruth
 
Oh, and if I can follow up with one piece of advice for those with rib incisions.

I spent some dedicated time at cardiac rehab and later at my gym working on the muscle on the right side that was cut and I'm glad I did. I had some weakness at first but the rowing machine and lat pull-down weight machines became my friends for strengthening the muscle that was cut. At 10 months out any weakness on that side is pretty much gone altogether.

Peace,
Ruth
 
Great Post!

Great Post!

Kandice, I am sure many will find your post very valuable. Generally speaking, the more factual information we have, the better our decisions will be, or at least the more comfortable we'll be with them. Brian
 
Wow...here we go again with differing opinions from different surgeons. We were told that there was a lot less chance of infection and less pain. My husband's driving restriction was lifted 2 weeks after surgery. He's been driving without any problems. He went back to work part-time after three weeks. His words are "I'd definitely recommend the minimally invasive procedure!" Just thought we'd add out 2 cents. LOL

shellyb
 
The worst part post-op of my port access right thoracotomy approach was the muscle spasms in my rib cage. I also had to have a rib removed to increase access and wired back in place at the end of surgery. Now over 4 years later it is still tender to touch. I also have some lung damage that some of my doctors believe is a result of that approach. Anyway, even with that I had successful surgery and a good recovery.
 
I had an anterior right thoracotomy. It was not called minimally invasive and my incision is about 6 inches long. I always thought that minimally invasive is a port access as well. My incision starts close to the sternum and follows the contour of my right breast. I'm told that a traditional right thoracotomy is usually more on the right side, not toward the center and is very painful. I'm only 10 days post-op, but I'm experiencing very little pain. I have minimal back pain and full range of motion in my arms. I'm able to sleep on either side without discomfort. The biggest source of discomfort is in my leg where they accessed the femoral artery for the heart-lung machine. I'm only taking extra strengh tylenol during the day and Ultram at night for pain. I have nothing to compare this to but I'd do this over in a heart beat...ha,ha. :p
 
Kandice. Thanks for sharing your experience. I know it will be quite useful to those needing to make a choice. And it has brought up some great (and typical) contrasting comments from all those who have had that type of surgery.

In some ways, I wish I had looked into minimally invasive surgery...simply because my sternum incision has hypertrophied, isn't very pretty, and is quite painful still, at 18 months post-op. Chances are, I suppose that any scar would have done this, but all my favorite pendants are not longer part of my wardrobe because they hurt to wear....would that the scar were buried under a breast somewhere!! :p Small potatoes in the grand scheme of things.

While it is important to hear everyone's experience, it is never wise to compare things on an emotional level. We each have our own journey and for whatever reason experience things in our own unique way.

Sounds like your recovery is now going beautifully!! And bet you didn't know how tough you were 'til you had to experience all that pain. Way to be tough!! Good job!

Marguerite
 
My husband had minimally invasive MV repair in May 2007. (Same surgeon & hospital as MaryC.)

Dr. Ryan did not mention that the incision is supposedly more painful than a sternotomy. However, we were told that by my surgeon, whom we saw for a consult. But he said he'd do it, if John was set on it.

John did have some swelling. I kidded him that he looked like he had had breast enhancement :eek:. The swelling finally resolved.

He believes he had less pain than I did with my surgery. My chest was quite sore for 2-3 months + my back hurt like heck for almost that long. He had no back pain & little chest pain.

He did have some fatigue, but you get that with any major surgery. However, he was in far better physical condition than I was pre-op, so his recovery was much faster than mine.

I don't intend to have a re-op, and I don't know if I'd be a candidate for a port-access incision, but based on John's experience and that of MaryC and several others, I'd sure go for it, if possible.

BTW -- not all patients are candidates for a minimally invasive procedure. We were told that overweight people and large-breasted women aren't good candidates. And I believe one of the two surgeons said something about diabetics in general having more problems with healing, which is to be expected.
 
Great post Kandice. My first OHS was through a heart port and I was mistaken that it meant it would be less painful - boy was I wrong, it was SO painful that the second time around when I was told they'd have to go through the sternum, I was glad. Of course, there is a trade off, which is the big scar. I don't know that I would do it any differently if I had to do it again, but it was all a big learning experience. Definitely more pain and slower recovery (for me) with the heart port. Of course, though, I never was fully well since I had to have the second OHS. Anyhow, just my 2 cents :eek:
 
11 days out

11 days out

Kandice said:
I 've had numerous well intentioned people tell me I am lucky to have the minimally invasive approach because its less painful and easier.
Some of this information is correct but some is wrong.
My 3rd day post op we had a conversation with the cardiac fellow that works with Dr Patracek I was concerned because I had gotten out of control with my pain the day before and was continuing to have trouble with pain management. He explained that the minimally invasive or he called it a thoracotomy is one of the most painful surgeries people can have. The reason being is they have to go through muscle and nerves and spread the ribs. He stated that the traditional sternotomy is still painful but because the bone is so close to the skin there isn't muscle or major nerves to go through. That made me feel better because I started thinking something was wrong.

Yesterday I talked to my cardiologist and she also stated that some surgeons elect not to do the minimally invasive due to pain management. She stated people hear the word "minimal" and assume that it is easier.

After all this I still recommend the procedure because there are real medical benefits, although I think everyone is different and we should make this decision with a trusted doctor.
I think in the long run that I may heal faster than the sternotomy,

Discharge instrctions per Dr. Patracek:

1. Walk everyday!!
2. Take it easy for 12 weeks
3. No lifting for 8 weeks !!!!
4. No driving for 8 weeks
5. Monitor BP twice daily, take temperature daily
6. Keep BP systolic under about 130 with exercise.

I hope this clears up and helps those who choose this procedure , not to scare peoplet but to give the real information.
Kandice

Kandice - I had "minimally invasive" surgery on 10/22. No one said it was a more painful surgery - and I didn't think to ask that. I can't say I've had much pain since they removed the drainage tubes. The only severe pain I had was in the middle of the night on day 2 when I woke up in pain with every breath - I kept trying to stretch out my body thinking that would help. It didn't. They gave me more darvacet which didn't touch it, then a shot of something and again an hour later - that did it! It went totally away when the docs finally came in to remove the tubes. I've had such memory loss that I really can't remember the explanation for that pain. I don't even know what the technical name for my surgery is, but the incision is on my sternem - it's 4" long and is glued together. I'm told I have wires that tied my sternum together. Pre-surgery, the doc told me he only needed to expose my aorta and value - not my whole heart - hence what I thought he meant by "minimally invasive". Since being home from the hospital, I've taken few darvacets - and the last few were 1/2 tablet. I've used ex-strength tylenol today and yesterday. So, only being 12 days out, I can't imagine the pain being much better - I did have open heart surgery! It amazes me really, what my body went thru and that I'm sitting here at the computer writing about it!
my discharge instructions are similar to yours - walking everyday being the biggie. He did tell me not to walk outside if it's under 45 and it's getting close to that now. The malls are an 1/2 hour away, so not sure how I'll get the walks in then. I can't wait to get back to Curves. I go to the cardio on Tuesday, so can't wait to see what he has to say.
(Sorry about the long post! got carried away!)
 
Just wondering

Just wondering

I haven't done my homework but I thought someone on here would know the answer. Is the port access and right thorocotomy the same procedure?
 
My husband had three heart valve surgeries and two lung surgeries. He did tell me that the two lung surgeries were much more painful than any of his heart surgeries. That being said--

His third heart valve surgery was a HeartPort procedure through the side as you had. His pain with this surgery was less than he had with a sternum approach, and he was up and walking much sooner than with his traditional surgeries.

He did tell me that the "through the side" minimally approach was easier for him, and he had several experiences to compare it to.

I think everyone is different in the way they heal and handle pain.

I know that Joe's pain threshold level was very high, probably just because he had had so many operations and procedures.

So, I think everyone's experiences are valid, some have a difficult time, others do not. It's all individual.
 
Thank you Kandice for your informative explanation.

It would be good if we could get Precise Definitions of all of these terms: Minimally Invasive, Port Access, Heart Port, and Thoracotomy, for completeness.

I believe there are at least 2 types of Minimally Invasive surgeries,
1- a 'short cut' of sternum (and perhaps an accompanying cut to the side), and
2- a Thoracotomy (through the ribs).

Do they ever go through the ribs on the Left Side?
Is going through the rigs on the SIDE also considered a type of Thoracotomy?

It seems the more we learn, the more we learn we need to learn :)

'AL Capshaw'
 
I missed this post last fall; I'm glad it was revived because, Kandice, your explained your experience very well. Thank you for it.

AL, you raise some good questions. It would be nice to have some more exact definitions of each procedure.

Perhaps a compilation in a sticky thread would be beneficial?

I have written about [the following] previously but will add my personal experience again to this particular thread: When I had my coarctation repaired nearly three decades ago, the incision began beneath my left arm and continues in a rounded way across and up my back--I have heard it referred to as a "J cut"--and it was/is 12 inches long. It was an extremely painful incision to heal because of all of those muscles that are cut and I was told then that it was much more painful than a sternotomy but I would heal faster overall. Early post-op, I could not even move my left arm, in the least bit, on its own power. Shocking pain, among other things.

I can now compare the two surgeries, in my experience, and the pain/healing comparison information was accurate in my case. That said, however, the muscles never healed back together smoothly and my back incision healed a bit like a puckered quilt. Of course, it's easily hid. It also still has some strange occasional feelings of itchiness and some creepy numbness in places. One silly doctor used to exclaim in surprise each time he saw it and he would ask me if I'd had lung surgery :rolleyes: .
 
thoracotomy

thoracotomy

ALCapshaw2 said:
Thank you Kandice for your informative explanation.

It would be good if we could get Precise Definitions of all of these terms: Minimally Invasive, Port Access, Heart Port, and Thoracotomy, for completeness.

I believe there are at least 2 types of Minimally Invasive surgeries,
1- a 'short cut' of sternum (and perhaps an accompanying cut to the side), and
2- a Thoracotomy (through the ribs).

Do they ever go through the ribs on the Left Side?
Is going through the rigs on the SIDE also considered a type of Thoracotomy?

It seems the more we learn, the more we learn we need to learn :)

'AL Capshaw'
Al, this link may answer some questions as far as defenitions:

http://en.wikipedia.org/wiki/Thoracotomy
 
shellyb said:
Wow...here we go again with differing opinions from different surgeons. We were told that there was a lot less chance of infection and less pain. My husband's driving restriction was lifted 2 weeks after surgery. He's been driving without any problems. He went back to work part-time after three weeks. His words are "I'd definitely recommend the minimally invasive procedure!" Just thought we'd add out 2 cents. LOL

shellyb

Shelly -

Could you tell us exactly where your husband's incision was made?
Starting and Ending Points, Vertical or Horizontal cut?

'AL Capshaw'
 
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