Minimally invasive?

[SteveK]

Hi, My name is Steve, I am 37 years old and scheduled to have AVR and removal of a membrane partially blocking the aorta on Jan 6th at the University of Michigan. (I have had the problem since birth with no symptoms, but they tell me they need to fix it now as heart is slightly enlarged and they would rather work on a healthy heart etc...)

I have been reading many of the threads and personal stories on this site for many weeks now; mostly to do with valve selection. (Very helpful and yet not; as their is no clear answer, and one day I am happy with my decision and the next I read some more
and begin doubting myself again)
I have decided on a biological valve for the following reasons:
1. I am a very active hunter and fisherman and spend hundreds of hours in the woods/rivers/lakes each year, much of this time I am by myself.
2. There is a 20% chance the membrane may grow back and need to be removed again. (The valve could be replaced again if necessary, Hmmm, Do you think my HMO would pay for a new valve if the old one wasn't completely worn out yet?)
3. My surgeon (Steven Bolling) recommends the biological, and thinks the new ones will last longer than the old. (no guarantee of course)

My question is concerning minimally invasive surgery. While talking to the surgeon about valve selection I asked him about this and he said he would be doing minimally invasive and that the incision would only be 6 inches. Does normal open heart surgery have a larger incision than 6 inches? Or does anyone know if it will possibly be three inches down and three across?
(I realize these are things I should have asked the surgeon but it is hard to ask all the right questions with a million things running through your mind during the appointment)

 

[Ross]

Hi Steve and welcome into the forums

Sounds like you've been doing your homework. As far as valve choice, it's a personal decision that you must make and it seems you've made the right choice for yourself. There is no right or wrong choice except to do nothing.

As for your insurance--They'll have to pay for whatever the surgeon sees fit to do. You should not have to worry about that at all.

Normal fully blown open heart surgery will leave you with a scar from 12 to 18 inches long and is lengthy to recover from. Minimally Invasive is much less intimidating, though it is still serious surgery and still does require a bit of time to recover, it's not as painful as the full blown deal. I'll let Christina L anwer about the incision. She just had her's done not to long ago. If the surgeon isn't comfy with small incisions, don't push it. I would rather him have all the room in the world to do the job right then to be restricted by an incision that might otherwise be too small.

 

[Christina]

Hi Steve,

Welcome to our family at VR.com. You've come to the right place so ask away.
My surgeries were in 8/2000, and I have a 9 incher. (read my personal story for details)
I am not aware anyone having a much bigger scar than mine. Maybe Ross does, I don't know, but let him tell you his personal story.
I think there are a few members that have had minimal invasive surgery. Minimal invasive is still surgery and don't be fooled by that. It is still serious stuff. I am with Ross, give the surgeon all the room he needs to get the job done right, because you don't want to do this too often.
As for valve choice, that is a very personal choice, and only you can make this. I personally got a mechanical and I hope I NEVER have to do this again. I am on Coumadin, am home testing and am doing great. I do whatever I did in the past and my life is very busy. If I cut myself it doesn't take much more to stop the bleeding.
In case of an emergency I do wear a "Medic Alert" bracelet every day that tells the EMT's that I have a mechanical valve, allergies and that I am on Coumadin.

Wishing you all the best.

 

[Nancy]

Hi Steve-

Welcome to the site.

My husband had a type of minimally invasive surgery called HeartPort surgery that is done through the side and ribs. His was a mitral valve repair. Not every surgery is amenable to this type of surgery, and not every patient is a candidate. There are also mini-sternotomies which are considered minimally invasive.

I guess it all comes down to what has to be done in there and how your surgeon feels about it.

Best wishes.

 

[bvdr]

I had the heartport procedure for mitral valve replacement in August. I don't think I would go that route again but that is just my personal experience. I do think the better they can see the better off you are. I know it really increased both the time I was on the table and the time I was on the pump.

I grew up in St. Clair Shores, MIchigan. What city do you live in?

 

[MelissaM]

Howdy,

Welcome to the site. I am a big fan of the minimally invasive procedure down the breastbone (I've heart the procedure through the ribs can be more painful - more nerve endings there - but will let those who have actually had this procedure weigh in). The Cleveland Clinic does approximately 80% of their valve surgeries by this method and are very experienced at it - my scar is only 2 1/2" long! They basically cut the breastbone from the 3rd rib down to the 5th rib and go into the heart from the top. It is essentially a laproscopic procedure, which is why not every surgeon is comfortable doing it. But, I tell ya, I am sold on it. I felt it contributed to my speedy recovery and lack of complications post-surgery.

Good luck with your decision!

Melissa

 

[Kenny F]

Melissa I had been meaning to ask you about your MIS. For aortic valves I was under the impression that it was very difficult. The thru-the-rib MIS I thought was more mitral. I do not fully understand how they GOT to everything! I would love some more detail (too late now for me - I've got the 9 incher down the chest!).

Also my surgeon really felt from his studies that pain management of the rib MIS was causing real problems. Anybody know about this? That, coupled with the minimal aperture to work - like Ross said (and my best friend told me pre-op) you want to give them plenty of room to work!

 

[bvdr]

Hi Kenny,

It is hard to judge because I never had my sternum split but I was given a prescription for 90 oxycodone when I left the hospital and I did use them all. I had a lot of problems with muscle spasms in the right rib cage post-op. My lower sternum is still very tender and I don't know if that is common or not. I'm only the second post-op heartport patient that my cardiologist has had....the other being the father of one of the other doctors there, and he died from lung complications.

But on the other hand.............I don't have a scar on my sternum. If I had it to do over, I would do it differently. I think women need to consider what else resides on their chest as well.

My surgery was mitral rather than aortic though and I'm sure the approach is much different. I was able to drive at 2 weeks though and had no restrictions after 3 weeks which was very nice.

 

[Nancy]

HeartPort OK here

HeartPort OK here

Joe's HeartPort procedure was less painful than his sternum procedures, and his recovery was a lot easier. His ribs were just spread apart, and not broken. The incision was a couple of inches, and under his breast area. He did have a couple of small incisions through the ribs for instruments, and a good sized one in the groin.

We also have a friend of the family who had HeartPort for a myxoma, done by the same surgeon as Joe, Dr. DePan. She was mightily pleased with her incision. Hers is hidden under her breast, and she also had a fairly easy time post surgery.

 

[MarciaB]

Steve-

I had a full sternotomy when I had my mitral valve replace on Dec. 9th. My scar is only 4 1/4" long and I'm still amazed that it could be done with so small an incision. I have some pain from the sternum area, but not much, I understand there are not a lot of nerves there. The muscles in my right shoulder are still a little sore. I decided to let the surgeon do it the way that was fastest and easiest for him, although he said he would do a horizontal incision under my breast if I wanted it. I assumed that they still would have done the sternotomy- but I may be wrong about that. I find that recovery has more to do with the heart muscle than the stuff they had to do to get there. Your endurance and stamina are shot to hell for a while after surgery. Sometimes I feel great, better than before surgery, other times I'm really tired and achy. I'm taking Darvocet at night and Tylenol during the day. I never coughed a lot and have yet to sneeze, so that stuff hasn't been a problem. I walked two miles yesterday and woke this morning on my stomach for the first time.

I think the main thing is that you and your surgeon should be comfortable with what you decide. His experience with what you choose is critical. I wouldn't want to be the guy's 6th minimally invasive patient! The longer you are on the table and on the ventilator is important for the first week or so, but diminishes after that. All of the recovery stuff is short term - the long term result is the one you live with. Good luck, I'm sure whatever you choose will be OK in the end.

Marcia

 

[maxximom]

If you have minumally invasive surgery..be sure that your surgeon has done a lot of them..some surgeons are much more experienced at the technique than others. I had AVR and triple bypass and although my surgeon does many minumally invasive surgeries..mine could not be done that way. I was vain enough to ask my surgeon to start my incision as low as possible. He granted my request and my scar starts between my breasts and extends down only 4-5 inches.. it does not show if I wear a V neck or anything a bit low cut. Most of my doctors including my cardio.are always suprised to see it done that way and say that they haven't seen one like that before, even though they have seen many surgeries done by my surgeon . The vein harvested from my leg for the bypass was done minumally invasive from my thigh near the bend of my knee, it is only about one inch long and almost invisable.
Joan
AVR,TripleBypass , St Judes Toronto Porcine Stentless Valve, Dr Donald Glower,Sept 25,2001,Duke Medical Center

 

[SteveK]

Thanks to all for the replies. I actually didn't ask for the minimally invasive surgery, I asked about it when talking to the surgeon about valve types. By the way he answered I think it is the way he does them all the time. Maybe I should ask to be sure he has done many this way. Also, I'm sure sure he is going through the sternum and not the side. Having worked on cars a time or two I understand why the more room the better!
BVDR - I am from a little town south of Saginaw called Chesaning.
I go for some pre-op testing tomorrow. I will check in with more questions I'm sure.

Thanks again,
Steve

 

[Gail in Ca]

I was under the impresssion that minimally invasive was surgery thru the rib and not the sternum.
My surgeon says he can do this to replace my mitral when the time comes.
Oh, and my scar from my avr redo is long, about 2 " longer than the original, total maybe 12".
Gail

 

[labguides]

minimally invasive

minimally invasive

As I understood what our daughter's surgeon said,
He will make incision under the right breast and "separate" the sternum. To me that sounds like "breaking" the sternum. Can someone clarify that for me?

 

[bvdr]

My incision in actually across my lower right breast but I don't know anything about seperating the sternum. They removed part of a rib and rewired that back in when they finished. I'll be interested in finding out what they mean though.

 

[SteveK]

I have been doing a little research and found what is called a "partial sternotomy". There is an upper and a lower version of this, of which upper is used for valve replacement. Instead of separating the entire sternum, they cut a few inches down the sternum and a few inches horizontally. It is supposed to be a little less painful and recovery and inpatient hospital time is supposed to be shorter.
Six days until surgery, I am going to stop researching now and try and relax until the day comes. I hope I don't catch my daughters cold or the flu that is running rampant around here, I just want to get this over with.
Steve

 

[Georgia]

Have a really good weekend

Have a really good weekend

Hey, Steve - have a nice weekend. I know you're probably really stressed about your surgery right now. Don't blame you. Take comfort in the realization that this time next week you'll be "done".

And you're right on track about not catching something now. There's so much junk going around you almost need to be in a sterile room! I went to my pcp's yesterday and scrubbed my hands twice after I got into the examination room - everyone in the waiting room looked awful (I was there for a nice, painful but non-infectious sciatica).

Treat yourself this weekend - good meals, good drinks, good movies, spend a little money on yourself. You want to do things that'll distract you.

And most of us experienced a truly deep calm shortly before surgery - right when we thought we couldn't get any more scared and stressed - a kind of acceptance washes over us.

I hope you have someone who'll post for you and let us know that the surgery went well. We worry.

May your mountain be a molehill and the truck miss you entirely. My thoughts and prayers will go with you.

 

[SteveK]

Thanks for the advice Georgia. I will enjoy the next several days as best I can. I am actually more worried about getting sick and having the surgery postponed than actually having the surgery.
I have to agree with many of you who have stated that this is harder on the spouse than the patient. My wife is usually a chatterbox, but on the way to pre-op testing Monday I could hardly get her to say two words. I just want to get in and get out and try to get back to normal so everyone can relax again.

I also wanted to let you and everyone else know that I will not be able to post until I get out of the hospital. My wife will be staying at a hotel in the hospital until I get to go home, So I can't have her post either.
My surgery is the 6th and they said if all goes well I will get to go home on the 9th or 10th.
So don't worry if you don't here from me right away.
Have a happy new year everyone and Go Blue!
Steve

 

[mamsram]

Steve,

I recently had an aortic valve replacement using min. invasive surgery. The scar is 4 in. long straight down from the top of my sternum.

I got a bovine valve. I'm 66 years old and in good health. The only question was my coronary arteries. The cath showed that (in the docs words) they were pristine.

If any follow up ops were anything like this one I would have no regrets about having to go thru it again. High pain tolerance? quick healer? If I was in excellant health, had a high tolerance for pain, and was a quick healer, and all of that makes a difference, then I guess I am very fortnate.

One thing I have wondered --do they do minamally invasive for mechanical valves???

I wish you as easy a time as I had--sneezed at 6 weeks-no problem GOOD LUCK

 

[KathyH]

Will be thinking of you next week Steve. Good Luck, will keep you in my thoughts and prayers.
KathyH.