minimally invasive versus sternectomy for MV repair for bileaflet prolapse

[catwoman]

One of the pre-surgery questions I asked my surgeon was whether he would have to change tactics and do the full chest opening procedure if there were complications or if the valve needed to be replaced instead of repaired. His answer was that for surgeons comfortable with doing port access (having done A LOT of them!) there was no difference in access and anything that could by done through the full chest procedure could be done through port access.

Sparklette:
My husband had the same surgeon as Katie D and her sister, MaryC, and he told us the same thing.
My surgeon said that the port access incision used to be standard, then surgeons went to a sternotomy. That surgeon prefers a sternotomy, but said if John chosen him to do the surgery, he'd do whatever incision he wanted.
John opted for Dr. Ryan, who has quite a lot of experience with the port access incision.

In fact, Dr. Ryan said if I ever required another MVR, he could do it via port access.

FYI: We were told that overweight people & very well-endowed women are not good candidates for a port access incision.

I can barely see John's incision now, and it's almost 16 months post-op.

 

[liza]

Hi Sparklette7!

I've had two heart surgeries...one was OHS through my sternum and the other was a minimally invasive pericardectomy 2 months later. I can tell you from my experience the bone pain from the sternum hurt less than the intercostal muscle pain from them going through my side. I healed faster from the second one though. I had to fight my surgeon for the minimally invasive approach as he *really* wanted to go through my sternum again. And he was the chief of cardiothoracic surgeons, so I know he was experienced.

I was very apprehensive about the zipper scar. However, it's been 3 years and I can barely see it! I went into my OHS expecting a mitral valve replacement and ended up with a repair. I got lucky. I had picked out a tissue valve to keep open the possibility of having children. Unfortunately I may still need to have my valve replaced in the future, at which point I will likely go for a mechanical. (I'm 27 right now).

You have some difficult decisions to make, but I would definitely have a back-up plan in case they can't repair. We will hope for the best for you though. Take care!

 

[sparklette77]

Adrienne--I looked into the evalve website a bit but not with any real seriousness because it is so new, no one knows the longterm effect and I would rather just have surgery as opposed to trying this new procedure and have to be constantly monitored for the clinical study.

Catwoman--did you mean to say that your husband's surgeon said the sternectomy approach was the standard and then people moved to the port/thoracotomy approach? Did your husband have a valve repair or a replacement? Also, would you be willing to tell me what the doctor said he chances of having a repair were (if you don't mind, you don't have to divulge this if you are not comfortable).

Liza--Will you tell me more about your sternectomy? Did they do that because they thought your valve would be a complicated repair? So far all the surgeons I have seen have agreed that my valve will be on the complicated side of the fence. Also for your plan B would you be willing to tell me what type of tissue valve you chose? And why do they think that you may need a mitral valve replacement at some point? Is it just a general thought that at some point your native valve repair may still breakdown at some unknown point later in life? Was yours a bileaflet prolapse?

Sorry to pepper you with so many questions.

Although I just thought of one more, do you have any kids now? And if so, did pregancy put a huge strain on your mv repair?

 

[liza]

I had written up a nice response and then the internet swallowed it up! Darnit!

I had chosen the sternectomy since the surgery involved the inside of my heart, and it just made me feel better to know that the surgeon had full access to my heart. My scar is only about 3 inches long, so even though they cracked my entire sternum open, they only incised a small amount of skin. The second surgery only involved my pericardial sac, so I felt more comfortable choosing the minimally invasive route, even though it hurt like heck when I woke up!

I needed to have surgery on my mitral valve due to severe regurgitation caused by endocarditis. I had chosen a bovine pericardial valve since that was the gold standard at the time (3 years ago). They had to place a ring around my valve opening. So I traded in mitral valve regurgitation for mitral valve stenosis. It's still a strain on my heart, but not as bad as being too leaky. I probably can't have kids because I might go into heart failure, but I haven't looked too seriously into it yet. I get monitored with yearly echos but my cardiologist is confident it'll probably need replaced sometime in the future. But for now, I'm glad to not be on coumadin but not looking forward to another surgery. To be honest, I'll proably choose another sternectomy...but I'll cross that bridge when I get there.

Feel free to ask more questions! Take care!

 

[Adrienne]

My scar is only about 3 inches long, so even though they cracked my entire sternum open, they only incised a small amount of skin.

Although my scar is longer (6 inches), it could have been 8 inches had they incised all the skin. The first two inches on top were not cut. Instead, they pulled back the skin. So, my necklines don't have to go way up to the top.

 

[bodman25]

One year ago I underwent a thoracotomy instead of the sternotomy and I had many complications. They thought they could repair the valve but tried twice and had no luck and ended up replacing it. Other surgeons I have spoken with said the chance of fixong my valve would have been better with the sternotomy. Also during the surgery something happened to the aortic valve which is right next to the mitral. Therfore less than 1 year later I ended up going in for an aortic valve replacement. In my opinion they really don;t get as great of a view as with the sternotomy.

I have had it done both ways. In my honest opinion the sternotomy has been easier to heal from. I am still having issues with the nerves in my side from the minimal invasive thoracotomy and it has been over a year now.

Good luck with your decision. I in no way am trying to scare you but I thought you should know my story. I would research your surgeon and see how many they have done and if they have any malpractice issues along with any of them.

 

[Anne K Sippit]

I had MVR on June 23 2008 -

I chose the cracking of the sternum for the following reasons:

Less cross clamp time - hence lower risk of complications from anethesia.
The risk associated for the procedure was lower than the MI procedure
I had a 95% chance that the valve could be repaired (it was - I opted for a mechanical valve due to my age - option B)
I felt that I had minimized my risk for outcome D. And I did. Back to work after 6 weeks.

 

[sparklette77]

Hi Everyone--thanks for all the information. I finally made some decisions and just want to say thank you to everyone on this forum that shared their thoughts with me and helped me along so far. I've decided to have the sternectomy approach with Dr. Adams at Mount Sinai (mitralvalverepair.org) and my surgery date is December 1, 2008. I was hoping to have it earlier, around November 1 but those dates were not available.

When I first found this website I was feeling crazed with wanting to know more and trying to decide what to do and not a moment went by when I didn't think about surgery but then recently I finally decided the approach, the surgeon and the date and now I feel much better and very comfortable with my choices. I also don't think about surgery in such an obsessive way! Now I am just hoping to get to it soon so that I can experience all the benefits that the doctors tell me I will have. Oh and I'm also looking forward to the vacation from work--I haven't had one in over a year so the post-op rest sounds very exciting.

I'm sorry I haven't posted in several days but I have been stuck at work with really long hours the past few weeks.

Anyway, December 1 it is and thank you everyone to helping me make these difficult decisions.

 

[Phyllis]

So glad that you have a date and I put you on the calendar. It sounds like you have done your research and feel confident with your choices- always a good thing! We look forward to seeing you through the surgery so you can enjoy your "vacation" when it is all done!

 

[Adrienne]

I just checked out the website you mention. Looks good!! Good luck. I'll bet you will feel really good to welcome the New Year in!!

 

[sparklette77]

Thank you Phyllis and Adrienne!!!

 

[Eva]

So happy that you reached a decision, which is the hardest part of the whole procedure. I can feel your comfort and keep this attitude which will help you through the recovery too.
We all here will pray for you and encourage you to look forward to the better and healthier you after the surgery.

Good luck and prayers

 

[sparklette77]

Hey Everyone--turns out that my surgery date has been rescheduled due to the surgeon's schedule. So now it is scheduled for December 5. I know it's only 4 days later but I just wish it could be over with already!

 

[Phyllis]

So sorry for the delay, but I changed it on the calendar and as they say, "all changes work for a good reason". We will keep you in our thoughts and prayers.

 

[bodman25]

I think you have made a great decision. Good luck and keep in touch.