Minimally invasive surgery for replacement of cardiac valves

[Dennis S]

I have what I suppose a doctor would describe as a plain vanilla bicuspid aorta valve that needs to be replaced. I am nearly 50 yearts old and in pretty good health otherwise. I am preparing to face the "chest crack" surgery, and a lifetime of coumadin, starting around August 1st. (A severe mercy is how I see it right now). But once in a while I read on this site and other places a phrase like "Minimally invasive surgery for repair and replacement of diseased cardiac valves".

"Minimally invasive" has a nice ring to my ears, and I suppose would be a first choice for most all of us, if it is a choice. I will ask my surgeon about this on Monday, but the people on this site have a lot of credibility with me, and I would love to know what you think as I prepare to talk to the surgeon. Any advice would be greatly appreciated.

 

[Phyllis]

Dick had minimally invasive aortic valve replacement at Brigham and Women's hospital in Boston. It is a 3-4 inch opening of the sternum instead of the whole sternum. He had no pain from the incision. Recovery is about the same- 4-5 days in the hospital barring any complications and 3 months before back to sports, etc. The important thing if your are considering it, is to go to a hospital and a surgeon who has lots of experience performing it this way. It can only be performed if the arteries are clean and you don't need a bypass as well. There is a good video of Dr. Cohn at Brigham performing the surgery:
http://www.or-live.com/BrighamandWomens/1127/

 

[TjCarpenter]

I have what I suppose a doctor would describe as a plain vanilla bicuspid aorta valve that needs to be replaced. I am nearly 50 yearts old and in pretty good health otherwise. I am preparing to face the "chest crack" surgery, and a lifetime of coumadin, starting around August 1st. (A severe mercy is how I see it right now). But once in a while I read on this site and other places a phrase like "Minimally invasive surgery for repair and replacement of diseased cardiac valves".

"Minimally invasive" has a nice ring to my ears, and I suppose would be a first choice for most all of us, if it is a choice. I will ask my surgeon about this on Monday, but the people on this site have a lot of credibility with me, and I would love to know what you think as I prepare to talk to the surgeon. Any advice would be greatly appreciated.

Hello and welcome,

I can only say that I totally understand where you are coming from. I am a 45 year old man, two weeks out of surgery for exactly what you have. A bad aortic valve. I, like you, really liked the sound of the whole "minimally invasive" thing. Boy oh boy... anything but breaking my sternum...Please!

So, in earnest, I started my research. I found out everything there is... (Globally) on the subject of percutaneous or subcutaneous aortic valve surgery. Spoke with leading surgeons... the FDA... manufacturers of the pioneering new devices... got on waiting lists for surgery... Get the idea? Anything but breaking my sternum... PLEASE!!!! Guess what... They broke my sternum, put in the best PROVEN valve available... in the current GOLD STANDARD method and I am JUST FINE (except they broke my sternum... just kidding, still just fine). Let me not trivialize your feelings. As I said, I totally understand where you are cominf from and respect your ongoing research into the subject. Just know this... if you end up with the reality of conventional open heart surgery, all will be fine and it is OK to be a bit scared. I sure was. The worst part of the whole thing was all the time I spent fretting BEFORE the surgery. I am now whole again and my future is quite bright. That said, it WAS a trip getting here, but you will be very well supported and they really know what they are doing. Some things to research... Carpentier Edwards, Corevalve for example, are new technologies that are not yet really ready for general public consumption... In the future, probably... But for right now, it would definitely be guinea pig'sville and I really like my progress with the gold standard surgery. I would say "hey, it's not that bad..." BUT I don't what to go there. It is an event, for sure. Just not as bad as I thought it would be.

Sorry for the rambling... There are lots a folks on this site that know a ton more than me. But, I really felt that I could relate to your feelings. Hope this helps.

Best of luck and God bless,

Tom

 

[Nancy]

Joe had a minimally invasive procedure through his side (ribs, using HeartPort method)) to repair his mechanical mitral. He did just fine with it. It was probably one day shorter in the initial recovery phase, and he didn't have the sternum issues to deal with, but it is a MAJOR surgery nonetheless, and there are several access areas which are painful, plus going through the ribs bangs them up too. The heart still is under stress. The surgery was just about as long as ordinary heart surgery.

It was Joe's third valve surgery.

 

[TjCarpenter]

Joe had a minimally invasive procedure through his side (ribs, using HeartPort method)) to repair his mechanical mitral. He did just fine with it. It was probably one day shorter in the initial recovery phase, and he didn't have the sternum issues to deal with, but it is a MAJOR surgery nonetheless, and there are several access areas which are painful, plus going through the ribs bangs them up too. The heart still is under stress. The surgery was just about as long as ordinary heart surgery.

It was Joe's third valve surgery.

Hi again...

Here is a link you might look into... Not the percutaneous thing, just an alternative type of incision. Hope it helps,

Tom http://www.umm.edu/heart/aortic_valve.html

 

[Dennis S]

thanks so much for your reply

thanks so much for your reply

If there are very many people who really do know more than you, I would like to met them. I sure love all you guys. I have a lot of friends that wan to help, but it is so good to have friends who know so much about OHS!

Hello and welcome,

I can only say that I totally understand where you are coming from. I am a 45 year old man, two weeks out of surgery for exactly what you have. A bad aortic valve. I, like you, really liked the sound of the whole "minimally invasive" thing. Boy oh boy... anything but breaking my sternum...Please!

So, in earnest, I started my research. I found out everything there is... (Globally) on the subject of percutaneous or subcutaneous aortic valve surgery. Spoke with leading surgeons... the FDA... manufacturers of the pioneering new devices... got on waiting lists for surgery... Get the idea? Anything but breaking my sternum... PLEASE!!!! Guess what... They broke my sternum, put in the best PROVEN valve available... in the current GOLD STANDARD method and I am JUST FINE (except they broke my sternum... just kidding, still just fine). Let me not trivialize your feelings. As I said, I totally understand where you are cominf from and respect your ongoing research into the subject. Just know this... if you end up with the reality of conventional open heart surgery, all will be fine and it is OK to be a bit scared. I sure was. The worst part of the whole thing was all the time I spent fretting BEFORE the surgery. I am now whole again and my future is quite bright. That said, it WAS a trip getting here, but you will be very well supported and they really know what they are doing. Some things to research... Carpentier Edwards, Corevalve for example, are new technologies that are not yet really ready for general public consumption... In the future, probably... But for right now, it would definitely be guinea pig'sville and I really like my progress with the gold standard surgery. I would say "hey, it's not that bad..." BUT I don't what to go there. It is an event, for sure. Just not as bad as I thought it would be.

Sorry for the rambling... There are lots a folks on this site that know a ton more than me. But, I really felt that I could relate to your feelings. Hope this helps.

Best of luck and God bless,

Tom

 

[jax3172]

my .02 cents

my .02 cents

You state, "...plain vanilla valve that needs to be replaced..."

I am the least educated of many of these folks but you may want to make sure your aorta is OK also (have you had a CT Scan of the chest with contrast?). Do your own research but I understand that many of us with BAVD have (or soon have) dilated ascending aortas and other little niceties that go along with BAVD. One of those is a higher incidence of aneurysms (of course, including the ascending aorta). If this is the case, then at least consider a tissue valve. Even if it's not 100% life threatening, if you have an aneurysm down the road, you may not want to be on a blood thinner. Just me talking but some food for thought. Smart people, set me straight.

 

[cgv]

cgv

cgv

I am a 58 year old male and had a Medtronics stentless porcine valve installed on May 27. I was fortunate in that the post surgery pain was minimal. I went home on May 30 and was able to sleep in my bed without any problem. No pain pills. Moving into a sleeping position and getting out of bed was a little uncomfortable, but certainly manageble.

Minimally invasive surgery sounds great and it might save a little pain, but it needs to be done by someone who has done many. It is also not possible to do for certain types of valve replacements. My surgeon said he wanted full access to the valve to ensure nothing was missed or compromised. I relate it to working on a car engine, it's a lot easier to see and fix things when you have more room.

I'm sure things are moving towards less invasive procedures with new valve designs and technology improvements such as they have done with arthoscopic orthopedic surgery (I had my knee scoped twice.) I would talk with my surgeon and develop a high confidence level in him (and make sure it's even possible in your case) before I made a decision.

 

[TjCarpenter]

I am a 58 year old male and had a Medtronics stentless porcine valve installed on May 27. I was fortunate in that the post surgery pain was minimal. I went home on May 30 and was able to sleep in my bed without any problem. No pain pills. Moving into a sleeping position and getting out of bed was a little uncomfortable, but certainly manageble.

Minimally invasive surgery sounds great and it might save a little pain, but it needs to be done by someone who has done many. It is also not possible to do for certain types of valve replacements. My surgeon said he wanted full access to the valve to ensure nothing was missed or compromised. I relate it to working on a car engine, it's a lot easier to see and fix things when you have more room.

I'm sure things are moving towards less invasive procedures with new valve designs and technology improvements such as they have done with arthoscopic orthopedic surgery (I had my knee scoped twice.) I would talk with my surgeon and develop a high confidence level in him (and make sure it's even possible in your case) before I made a decision.

Ditto... Same valve... Same kind of experience.... Same rationale by surgeon (better access to deal with what they find). My surgeon used a "plastic surgery" type of closure. It seems to be very fine and healed up VERY quickly. At two weeks, the sternum feels better than I expected, still no full contact sports! Good Luck, Let us know if we can be helpful.

Tom

 

[liza]

I had open heart surgery though the sternum 2 months ago, and just had "through-the-side" heart surgery 2 days ago. If you have a choice, my vote is to go through the sternum. I did not experience half as much pain when they went through my sternum as I have the past couple days. Even waking up and still out of it I could tell a major difference in the pain factor between the two approaches. I don't know if I'll heal faster in the long run, but for now the pain from the side is MUCH worse. Just my two cents.

Liza