Need help making decision

[KristiinSD]

I did my pre-ops today and felt good about the kind of care I was receiving at UCSD. I didn't meet the anesthesiologist nor see Dr. Jamieson (the surgeon) again, but everything was pretty smooth and the nurse practioner explained everything...

Then I had a second opinion appointment with another surgeon, Housman, at Scrippps Green Hospital. He does minimally invasive surgery using the Heartport and says his outcomes are the same as through the traditional method. He also said that the minimally invasive approach was more "tedious" so he gives his patients a choice...Women, he said, choose the heartport for the aesthetics.

So if evreything is the same, I feel like I should do the heartport. But of course, Jamieson doesn't think everything is the same...He feels a 4-5 inch cut down my chest is the best way to go and that surgical outcomes are not compromised...

Help! I am so confused and don't know how to resolve this issue. I could have surgery around the same time next week. Time in hospital is about the same, time not lifting about the same...just chest scar vs. no chest scar? And "nice" surgeon vs. less pleasant surgeon, but after the surgery I would only see either one once anyway...

You all have helped me so much as I prepare for this surgery, I hope you can continue to assist me with this decision.

Much thanks and gratitude,

Kristi
mr
syrgery 9/8/05?

 

[Paul_R]

I had asked Dr. Laks at UCLA about this and as I recall his answer to me was that the pain and recovery was the same but the procedure was more differcult. So he felt it didn't make sense to do minimally invasive. However, he would do it for women.

I don't know if this helps.

 

[Ross]

Kristi it's a hard call. My personal opinion is, let them have all the room in the world to do what they have to do, but I can also see where you might want minimal invasive. I still think traditional is the safer route, but it boils down to what you want.

 

[tobagotwo]

I would tie it to experience and the surprise factor.

I do believe that a well-experienced surgeon can have excellent outcomes with the heartport procedure. Thousands are done successfully each year. A number of people here have had their surgery done that way.

The surprise factor is that if anything unexpected is wrong, it will be more difficult to get to, smaller space, less visibility. Eventually, they will do much of this by robotic access and tiny tools (already being done in a very few places), but that's probably not an option at all for you.

Best wishes,

 

[Nancy]

Joe's had both. The recovery from the Heartport was slightly better, short term. But the heart is still operated on and the long term recovery was about the same. The surgeon felt he could see things well, but said that it's a slow process setting it up and then getting back out of the body, since there is long cannulation which has to be done and several instruments that have to be positioned.

There are several small openings that are used, one in the groin, one under the breast and several others through the side.

As far as surgeon's personalities, it really doesn't matter too much, as long as the person is extremely competent. You'll be asleep when he/she works their magic.

Being an excellent surgeon is the real important issue.

 

[Lisa]

Scar

Scar

Kristin,

I read another post in which you stated you do not want to have a big scar down your chest. I don't anything to offer with regard to the heartport; however, I can say that scar really becomes a non-issue. I was self conscious for a little while following surgery but now I just look at as my badge of life ! I almost forget about it when I see people staring...I'm thinking what are you staring at? Do I have something in my teeth?

 

[bvdr]

Kristin,

I had the heartport procedure and I do not have a scar issue though I think I have some other things now that I would rather not have. The way my cardiologist explained it is that the right lung needs to be deflated and actually moved out of the way for the procedure. I have scarring on my right lung and still have some shortness of breath that my cardiologist THINKS may be from the surgery itself. He doesn't KNOW since I also had radiation treatments when I was a teen and my father had pulmonary fibrosis so it is impossible to ever really know. I do know I had really bad muscle spasms in my rib cage following the surgery and I have a lower rib that is now wired into place that wasn't that way before the surgery. Another consideration in my case is the fact that I may need further surgery at some point for a couple of stenotic areas in my coronary arteries, in places that can not be stinted, as well as a couple of other valves that have been affected by rheumatic heart disease. So my sternum is in good shape for any future work.
I was on bypass a long time and do not feel as mentally alert as I once did.

On the plus.....I was allowed to drive earlier in my recovery and don't have a sternum scar. I didn't know I was going to have the heartport procedure until the night before surgery. I don't think I would do it again but I do like the thought that for future surgery I won't have all the re-op issues like scar tissue to deal with. ..............IMHO

I don't think you can make a bad choice either way.

 

[Big-Chuck]

Comments

Comments

I dont really have a comment about the type of surgery, only my surgeon from UCSD was Dr. Madani and he did an excellent job on me and he split me open. As I look back on it it wasnt so bad. Good days and bad days. Good days win out.

 

[KristiinSD]

You all are the BEST!

You all are the BEST!

I feel so blessed to have found this site. Thanks for all your input...I'm still wavering, but I think I might stay the course with the big whopping scar down my chest...My C-section scar is almost a pencil line that has faded a lot in the past 7 years, perhaps I will be as lucky with my sterum incision.

Kristi
mr

 

[Nancy]

If you already have scars that healed well, then it looks good for other incisions.

My husband, thank God, is a good healer scar-wise, since he's had so many operations.

All of his scars are very thin and faded to white now.

 

[Ross]

I feel so blessed to have found this site. Thanks for all your input...I'm still wavering, but I think I might stay the course with the big whopping scar down my chest...My C-section scar is almost a pencil line that has faded a lot in the past 7 years, perhaps I will be as lucky with my sterum incision.

Kristi
mr

Psst, hey Kristi, what these people aren't telling you is that it makes you look sexier!

 

[bvdr]

Psst, hey Kristi, what these people aren't telling you is that it makes you look sexier!

Kristi....the scar does accentuate cleavage REALLY and truly!

 

[Georgia]

Only accentuates cleavage if you have any to begin with!

 

[KristiinSD]

I've got cleavage...

I've got cleavage...

I told someone that my fear about surgery is that it would ruin the two things about me I really value: my cleavage and my cognitive ability! But now, it sounds like it may actually enhance my cleavage...hmmm...will it also make me smarter? I am a professor, so I need all the brain-power I can get.

Kristi
9/8/05 sugery

 

[LLJ]

Kristi: I am really enjoying this exchange! No real significant cleavage here,but the scar is no big deal. I am actually proud of it! I will say that it detracts from wearing really pretty summer dresses and I can't say it's necessarily sexy,but it is fading. I use a silicon bandage by curad that REALLY helps flatten and fade it. I also see from other posts in the past that time makes it very faint. My own surgeon told me the physician who was one of the pioneers of this heartport surgery had to have valve replacement himself. (I think he was from Brigham & Women's Hospital,but not sure) He had his surgeon do the sternum opening. It could be that he just thought no one could do it as well as he could but,......
Laura

 

[Ross]

"I've got cleavage..."

Kristi, Kristi, Kristi, you just fell for the biggest Ross trap there is!

 

[MitralMan]

I had minimally invasive. I think the real answer is...

I had minimally invasive. I think the real answer is...

1) Pick your surgeon
2) Let him/her do his thing (minimally invasive or not)

I went through the very same issue. My brother-in-law is a cardiac surgeon in CA (trained at NYU, Cleveland Clinic, Miami -- generally a total hot shot), but my surgeon was (still is) head of cardio-thoracic at NYU. Brother-in-law said: sternotomy. Definitely. Colvin at NYU said: minimally invasive. Absolutely.

I went with my surgeon's preference, and left it at that.

I'm a guy, so I don't really care about where the scar is located or who sees it (I'm not that good-looking to begin with). I was driving after two weeks (a big deal to me). And feel fantastic now. Just got the all-clear to train for a marathon (though my ambition at the moment is a 5 miler). I'm 48.

I'd look at the number of procedures the two surgeons have done and their outcomes -- and go from there. It isn't about personality, it's about results!

Though I have to say, in my case, that Colvin's got great numbers and is a heckuva nice guy.

Good luck!!

 

[KristiinSD]

Thanks all!

Thanks all!

I think I have made my decision to go with door # 3, a surgeon I met on Thursday after deciding to go with my first dr. I guess I feel that having an appointment with him was by the grace of God (I find I am becoming more spiritual as this saga continues) and that his experience is excellent and his knowledge very high. Walter Dembitsky is the head of cardiothoracic surgery at Sharp and said he does 2 to 4 mitral repairs a week...He also brought up several issues that have not been previously discussed with me, so I felt that his fund of knowledge was the best. He's also the MAZE man in my area, so I am feeling in good hands. Unfortunately, my insurance is being difficult, so it may be next month...

Kristi
mr

 

[MitralMan]

TRIPLE CHECK your insurance!! Get DOLLAR costs and reimbursements beforehand.

TRIPLE CHECK your insurance!! Get DOLLAR costs and reimbursements beforehand.

I'm STILL arguing with my insurance company (Independence Blue Cross). Even after going through all their paperwork in advance and getting all the necessary pre-approvals, they paid less than 10% on the surgeon's fee. Lesson? I should have asked precisely how much everything was going to cost beforehand, and then checked beforehand with the insurance company -- not percentages, actual dollar amounts.

I had an ablation for arrythmia, but what's the difference between that and the MAZE procedure?

I think I have made my decision to go with door # 3, a surgeon I met on Thursday after deciding to go with my first dr. I guess I feel that having an appointment with him was by the grace of God (I find I am becoming more spiritual as this saga continues) and that his experience is excellent and his knowledge very high. Walter Dembitsky is the head of cardiothoracic surgery at Sharp and said he does 2 to 4 mitral repairs a week...He also brought up several issues that have not been previously discussed with me, so I felt that his fund of knowledge was the best. He's also the MAZE man in my area, so I am feeling in good hands. Unfortunately, my insurance is being difficult, so it may be next month...

Kristi
mr

 

[barbwil]

ablation:Maze

ablation:Maze

I'm STILL arguing with my insurance company (Independence Blue Cross). Even after going through all their paperwork in advance and getting all the necessary pre-approvals, they paid less than 10% on the surgeon's fee. Lesson? I should have asked precisely how much everything was going to cost beforehand, and then checked beforehand with the insurance company -- not percentages, actual dollar amounts.

I had an ablation for arrythmia, but what's the difference between that and the MAZE procedure?

Concerning the difference bet. ablation and Maze, here is a brief description of the three types of ablation:
http://www.sjm.com/procedures/procedure.aspx?name=Surgical+Ablation
I am 4 weeks post-op from mitral valve repair and the Maze, doing amazingly well, but the Maze has to produce scars to rid one of the A-fib. Had a 24 hr Holter monitor the other day so am anxious to see what my rhythm looks like on that.