New (kinda...)

[Cooper]

Hi Everyone,

I have been posting on Heart Talk for a couple of weeks now and I just wanted to stop in and introduce myself. For those of you who know me this post may be redundant (sorry..).

My husband is the reason I am here. He is 42 yrs old and has a congenital MVP w/regurgitation. We were told in January that he needed to consider surgery. Since January we have seen three surgeons. The consensus is that the has a complicated valve because the deterioration is posterior and anterior. However, he has a good chance of repair (90% and 99%). My husband is essentially asymptomatic. His heart holter results showed some atrial fibrillation (not chronic) and his chambers are getting stretched from the regurgitation. Thus, he's been told not to wait too long.

My husband is currently trying to decide between two surgeons. Both surgeons do a lot of repairs/replacements and both are at volume facilities (NY Presbyterian -Cornell and NYU Medical Center). The main difference is that one surgeon does minimally invasive and the other does traditional OHS. Minimally invasive is very appealing but, above all, my husband and I want the best result regardless of incision.

Can anyone offer advice on how to decide and share your experience on both procedures (minimally invasive vs. breastbone)? Also, is there anything else I should be asking, considering, etc.... Any advice is truly appreciated.

Best,

 

[hensylee]

you aren't new - I remember you and I bet others do, too. You will see soon.
Nice to see you again.

You have asked the right question - that is "what questions should I be asking. There will be a host of answerers coming along soon to help out.

We have one or two who had minimally invasive, but I think it's generally not done - limited access to the heart, perhaps.

 

[sylviayasgur]

hi cooper,
i'm sorry i haven't been around on the site much lately... i keep saying i need to come back, but things come up and take up my time.

the 2 docs you are talking about.. craig smith or mehmet oz or eric rose or some other (at columbia pres) or dr. colvin at nyu????

many folks here have used doctors at both facilities and all are exceptional surgeons. it's nice to have choices isn't it _ even though it makes the decision more difficult?

there was someone who used dr. colvin who had avr and his recovery was very speedy. is there one surgeon your husband is leaning toward or liked more than the others? will each of them attempt to do a repair first?
please let us know. mentioning surgeons' names here is fine. chances are someone will recognize them and respond as well. either way, he is in good hands.

please keep us posted. wishing you all the best,
sylvia

 

[Phyllis]

Dick had minimally invasive aortic valve replacement at Brigham in Boston. His cardiologist told him it was like getting hit by a semi instead of a 16 wheeler. It is a 3-4 inch incision instead of the whole sternum. They can only do it if your cath is okay and you don't need bypass. He never had any pain or problems with the incision. He was in the hospital 4 days (dismissed on the 5th) and I would say his recovery time was about on par with all those on the forum who have had minimally invasive as well as those who had traditional OHS. His choice would be minimally invasive again if he had it to do over, but I think your biggest decision is which doctor you feel most comfortable with.

 

[Cooper]

Hi Everyone,

Thanks for your replies.

Ann - I wasn't sure how often people cross over to the other forums. So, I figured I'd post out story here as well. Thanks for all your advice to date.

Sylvia - There was a reason we didn't go to Columbia, but I've heard great things about Smith, Oz and Rose. We saw Leonard Girardi at NY Presbyterian - Weil Cornell. We also saw Aubrey Galloway at NYU. Galloway and Colvin work closely together. Both Girardi and Galloway said my husband's valve could likely be repaired (90% and 99% sure). We liked both surgeons equally. We know people who have been repaired/replaced by Girardi so that's a plus but Galloway and NYU have an excellent reputation as well. Minimally invasive is appealing but my husband is still trying to decide if he's comfortable with the procedure. On the flipside, he really does not want a sternotomoy. Tough decision....

Phyllis - Thank you for your information. Both surgeons told him he needed a cath before the surgery. I wondered why this was needed but now I understand... it's to make sure he doesn't have blockage. If he has blockage, then minimally invasive is out of the question, right?

Thank you!

Best,

 

[Phyllis]

Yes, if he needs bypass as well as the valve replacement or repair, than minimally invasive is out of the question. I would not be uncomfortable with minimally invasive as long as it is done by a cardiac surgeon that has many such surgeries under his belt.

 

[CCRN]

Hi Everyone,

I have been posting on Heart Talk for a couple of weeks now and I just wanted to stop in and introduce myself. For those of you who know me this post may be redundant (sorry..).

My husband is the reason I am here. He is 42 yrs old and has a congenital MVP w/regurgitation. We were told in January that he needed to consider surgery. Since January we have seen three surgeons. The consensus is that the has a complicated valve because the deterioration is posterior and anterior. However, he has a good chance of repair (90% and 99%). My husband is essentially asymptomatic. His heart holter results showed some atrial fibrillation (not chronic) and his chambers are getting stretched from the regurgitation. Thus, he's been told not to wait too long.

My husband is currently trying to decide between two surgeons. Both surgeons do a lot of repairs/replacements and both are at volume facilities (NY Presbyterian -Cornell and NYU Medical Center). The main difference is that one surgeon does minimally invasive and the other does traditional OHS. Minimally invasive is very appealing but, above all, my husband and I want the best result regardless of incision.

Can anyone offer advice on how to decide and share your experience on both procedures (minimally invasive vs. breastbone)? Also, is there anything else I should be asking, considering, etc.... Any advice is truly appreciated.

Best,

Hi

I work in the operating room and assist in performing the two approaches your husband has been offered.

The most important thing is confidence in the surgeon of your choice. There are benefits to both.......opening the sternum gives the ablility to visualize the entire area as well as address other problems not earlier identified such as a patent ductus arteriosis or atrial and ventricular septal defects that surprisingly, do show up in adults. The minimally invasive procedure reportedly lends to a slightly shorter hospital stay but patients report a much higher level of pain. In addition, I have seen patients expecting to have the minimally invasive procedure and wake up with a sternal incision. Both approaches have great outcomes when appropriate.

I have Aortic stenosis due to congenital bicuspid valve. I never thought I would concern myself about a scar but I suddenly realized I have a lot of v-neck shirts . I wish I had a choice for my surgery but my surgeon recommends the mid-line sternotomy incision. I am willing to agree to that because he does about 400 valves a year and I have confidence in him and his skills. I hope this helps and gives you many questions to ask both surgeons. I know I drive my whole group of surgeons I work with crazy....but I don't care because in the end I know it's me that needs to be satisfied so I may go calmly towards my surgery.

 

[Cooper]

Hi CCRN,

Does your hospital go through the sternum for minimally invasive (but smaller incision)? NYU goes through the right side of the chest in the 4th or 5th rib space. I've heard that going through the side is a more painful procedure. We questioned NYU about this. They said that when minimally invasive surgery was originally done (before mitral valve repair), they had to go through the left side and actually separate the ribs, which caused a great deal of pain. The mitral valve is repaired through the right side and, we're told, is not very painful. So, I'm wondering if the pain depends on where the incision is made.

Since you're a nurse, maybe you can answer something I've been wondering about.... How is the heart/lung machine is "hooked up" to the patient? Does it go through an artery in the leg, arm or neck? Are there additional incisions made for the H/L machine? Also, is the H/L procedure the same for OHS and minimally invasive?

Thanks for any advice you can offer.

Best,

Hi

I work in the operating room and assist in performing the two approaches your husband has been offered.

The most important thing is confidence in the surgeon of your choice. There are benefits to both.......opening the sternum gives the ablility to visualize the entire area as well as address other problems not earlier identified such as a patent ductus arteriosis or atrial and ventricular septal defects that surprisingly, do show up in adults. The minimally invasive procedure reportedly lends to a slightly shorter hospital stay but patients report a much higher level of pain. In addition, I have seen patients expecting to have the minimally invasive procedure and wake up with a sternal incision. Both approaches have great outcomes when appropriate.

I have Aortic stenosis due to congenital bicuspid valve. I never thought I would concern myself about a scar but I suddenly realized I have a lot of v-neck shirts . I wish I had a choice for my surgery but my surgeon recommends the mid-line sternotomy incision. I am willing to agree to that because he does about 400 valves a year and I have confidence in him and his skills. I hope this helps and gives you many questions to ask both surgeons. I know I drive my whole group of surgeons I work with crazy....but I don't care because in the end I know it's me that needs to be satisfied so I may go calmly towards my surgery.

 

[Barry]

I'm skeptical about the a-fib not being chronic - and if it is chronic, treatment of choice is Coumadin/Warfarin, so whether or not I was going to have to take that stuff would certainly color my decision on valve-selection. I've got chronic a-fib and a St. Jude's metal valve.

Check with your doc, but to me "chronic" refers not to how intense something is (that would be whether or not it's "acute"), but to how long it's been going on. Apparantly they think it hasn't been going on that long. But are they doing anything to reverse it? I think the usual two ways of doing that are electroshock and amiodarone. They tried amiodarone on me but it didn't work (if they try that stuff, read up on it: It's got a wierd assortment of side effects, very toxic stuff, although I gave it a try anyway. But was annoyed that I had to find that stuff out myself and that the docs didn't do real informed consent by telling me. With any new drug, ask the pharmacist for the med insert, and then read it with a grain of salt (you'd think aspirin was poison))

Anyway, someone here correct me if I'm wrong, but if the a-fib exists and they don't fix it, if it's not chronic now it will inherently become chronic.

The more recent the onset of a-fib, the more likely the electroshock is to work. They were pretty sure mine was chronic from the time they spotted it, so they didn't try electroshock on me.

 

[ALCapshaw2]

My A-Fib was intermittent and brought on by exertion (anything more strenuous than walking the dog).

My Cardio was able to control it with the generic form of BetaPace (Sotalol).

IF you are going in for surgery, they can also do a MAZE procedure at the same time which involves 'burning' some lines across the heart to disrupt the pathway for the electrical impulses which cause the A-Fib. This procedure is an 'artform' and not always successful. I don't remember the percentages.

'AL Capshaw'

 

[Wise]

My A-Fib was intermittent and brought on by exertion (anything more strenuous than walking the dog).

My Cardio was able to control it with the generic form of BetaPace (Sotalol).

IF you are going in for surgery, they can also do a MAZE procedure at the same time which involves 'burning' some lines across the heart to disrupt the pathway for the electrical impulses which cause the A-Fib. This procedure is an 'artform' and not always successful. I don't remember the percentages.

'AL Capshaw'

Is the MAZE procedure the same as a cardiac ablation? I had an ablation about a year ago. It helped me a lot. I do realize that the "electrical path" they "burned" can return, but so far it has helped me.

 

[CCRN]

Answer to question

Answer to question

Hi CCRN,

Does your hospital go through the sternum for minimally invasive (but smaller incision)? NYU goes through the right side of the chest in the 4th or 5th rib space. I've heard that going through the side is a more painful procedure. We questioned NYU about this. They said that when minimally invasive surgery was originally done (before mitral valve repair), they had to go through the left side and actually separate the ribs, which caused a great deal of pain. The mitral valve is repaired through the right side and, we're told, is not very painful. So, I'm wondering if the pain depends on where the incision is made.

Since you're a nurse, maybe you can answer something I've been wondering about.... How is the heart/lung machine is "hooked up" to the patient? Does it go through an artery in the leg, arm or neck? Are there additional incisions made for the H/L machine? Also, is the H/L procedure the same for OHS and minimally invasive?

Thanks for any advice you can offer.

Best,

If you have the minimally invasive procedure the surgeon will cannulate the aorta and vena cava through a groin incison. It's pretty neat. The venous cannula (tube) is very long and reaches the right heart. The patient will have a right chest incision about 3-4 inches long below the right breast and an incision about the same size in the groin area. With the traditional sternal approach, the aortic cannula is placed in the aorta above the aortic valve and the venous cannula/s in the right heart. Please bear in mind your surgeon may differ slightly in technique and I am reporting what I see at my institution. I've not seen any neck hook ups. The H/L does the same job either way it's attached. As for the pain factor, the post op nurses who work for my surgeon beg to differ on that report. It's thoracic surgery. Ask again about the pain and ask how it compares to a thoracotomy.....because it is described as a "Thoracotomy approach" in every operative description I've seen. I believe one of the users of this site has had a thoracotomy. Might want to ask that person about the pain factor. There are benefits to both approaches. Hope this helps.

 

[Cooper]

Barry - I may be using the wrong term... My husband's holter showed 10 beats of "what looks like" ventricular tachycardia and 3 beats supraventricular tachycardia. Is this considered AF? His holter report does not specifically use this word. His Cardio and surgeons believe the irregular beats are caused from his valve. The one surgeon wrote that his atrium is getting stretched and "his risk of AF was significantly increased over the next 1-2 years" if the valve is not repaired. What do you think?

Al - The surgeons believe his episodes of irregular heart beat are caused from the valve and will go away (or remain unchanged) after repair. However, we did discuss the MAZE and all three surgeons did not recommend it for him. One mentioned that it might even cause him to go into chronic AF. All three mentioned that it doesn't always work (like you said). He is on Altace but I don't think it's specifically for the AF... we were told it helps take the load off his heart.

wise smith - Yes, the MAZE procedure is the same as ablation. I'm really glad to hear that it's helped you. From what we've been told, it doesn't always work. Thank you for your input.

CCRN - Thank you for the explanation. I've been wondering how this is done in minimally invasive. Also, thank you for the proper terminology, "Thoracotomy approach". I will post the question. I'm getting a real education in cardiology these days.

Thank you to everyone!

Best,

 

[Barry]

Barry - I may be using the wrong term... My husband's holter showed 10 beats of "what looks like" ventricular tachycardia and 3 beats supraventricular tachycardia. Is this considered AF? His holter report does not specifically use this word. His Cardio and surgeons believe the irregular beats are caused from his valve. The one surgeon wrote that his atrium is getting stretched and "his risk of AF was significantly increased over the next 1-2 years" if the valve is not repaired. What do you think?...

Basicly, I haven't got a clue. My understanding is that AF is when the atrium chamber of the heart spazzes out and begins doing exceptionally rapid beats that aren't coordinated with what the rest of the heart may be up to, and that the primary hazard associated with this is that clots will form (thus Warfarin/Coumadin for folks with AF). Although I think if it doesn't stop eventually it'll kill you since your heart isn't actually pumping much if at all while this is going on. Before you freak with that last piece of info, please note that I've got chronic AF and I can't say that I spend any time worrying about it.

A thoroughly excellent resource for medical info that you may want to check out is the Merck Manual, available online at http://www.merck.com/mrkshared/mmanual/home.jsp

Type in "atrial fibrillation" in the search engine and see what comes up.

 

[RCB]

Not the same

Not the same

, the MAZE procedure is the same as ablation. I'm really glad to hear that it's helped you. From what we've been told, it doesn't always work. Thank you for your input.

While these procedure attempt to cure the same problem- they are two different procdures. Do a search for "Cox-Maze procedure" and for "Ablation"
You are getting your terms mixed up.(Where is TOBAGOTWO when you need
him) Real basically, The Maze procedure was developed by Dr. James Cox while he was at U. of Wash in St. Louis. It is OHS that cuts the atria, then is sewn back together and forms a scar tissue maze to block the flow of electical signals from the SN. Ablation is a general term from ANY method which does the same and it can be microwave, freezing or HIFU. This can done percutaneaously, while maze is not.

 

[Cooper]

Barry - I don't know if it's the same either. One surgeon called it SVT and the other said he had an episode of AF, per his holter results. Hopefully, if it is AF the repair will either help or stop it. I sure hope they can repair his valve after all. Like you said, if he's having AF, that plays into his decision on valve selection if he needs a replacement.

RCB - Thank for clearing that up. Our Cardio said it was the same thing but she probably just didn't want to go into a long explanation. I know that the MAZE procedure was not recommended for my husband so, perhaps, another type of ablation would be an option (when and if the time comes). Are you really the world's longest surviving heart valve recipient? That's amazing. Thank you!

Best,

 

[RCB]

Cardios...........

Cardios...........

.

RCB - Thank for clearing that up. Our Cardio said it was the same thing but she probably just didn't want to go into a long explanation. I know that the MAZE procedure was not recommended for my husband so, perhaps, another type of ablation would be an option (when and if the time comes). Are you really the world's longest surviving heart valve recipient? That's amazing. Thank you!

Best,

Cooper,
You may be right about your cardio., they don't like to give long explanation. Both procedures try to affect the same thing, but are different animals altogether. The Cleveland Clinic website has a good explanation of each procedure.

As far as my research tell me, I am the world's longest surviving heart valve recipient. The first SURVIVING pt. died in the late '80s(Dr. Harkin's),
the second pt. died two months after surgery(Dr. Braunwald's pt. who some say doesn't count because the pt. didn't live full six month- BUT I COUNT HER!), the third pt. died ten years after surgery by falling off a ladder while
painting a house and Fourth pt.- Amanda Dao(not related to Cosgrove's pt. Anna Dao) who I have been searching for since 1998 seems to have disappearred(might have moved back to China?) both are Starr's first pts.
If Dao shows up - I will gladly hand the title to her, because am the only one after that. I am 99.999 % sure. There is one cardiologist from Indiana who claims the title, but I have him beat by about 6 months. I wrote to him about it and he never replied- that's okay he is in his 70's- let him enjoy his title. It is really not worth anything, how I wish it was.

 

[Cooper]

Hi Cooper

Read your email and responded..

But thought I should respond here too..

As you know I had minimally invasive surgery at NYU by Dr. Colvin...It was very successful and I think the recovery, as far as the chest is concerned is much less painful, not to mention the size of the scar.

I would bet you that if your husband meets Dr. Colvin, he would without question opt for the minimally invasive approach. Dr. Colvin, probably like many surgeons is very confident and sure of himself. I really liked his personaility and sureness of his comments. He trained many other doctors in this surgery and I have the utmost confidence in him. I think he is a great man..You will have to wait forever in his waiting room...but just seeing him made me feel many times better.

He made me laugh and made me feel very very comfortable. This of course was key for me..

Please contact me any time if you have any questions that I can help you with.

Mark

Hi Mark,

Thank you. I just read your reply. I haven't checked in here lately. My husband is going to have surgery at NYU but with another sugeon. I'll keep you posted and, again, thanks for all your info.

Best,

 

[Nancy]

Joe has had both types of heart surgery. Sternum approach for two valve replacements (aortic and mitral), and the HeartPort method for a mitral repair.

Although the time in the hospital was probably shortened by one day or so with the minimally invasive , and the initial recovery was shortened by a couple of days, there was different kind of pain to contend with. Sternum, of course involves bone healing, and the "through the side, under the breast and groin" has a lot of banging around type soft tissue healing that is quite painful as well. I asked him a while ago which he thought was better or worse, and his comment was that they both had pain and healing issues although in different areas.

The reason that minimally invasive was a good choice for his third surgery was to minimize more trauma to his twice operated on sternum area, with its attending scar tissue and adhesions.

By the way, the subsequent healing was about the same. It is, afterall, cardiac/thoracic surgery and stresses your body no matter how it's done. With the sternum incision, he had one long scar, with the HeartPort method, he had a groin incision, under the breast incision, and various small access incisions through his side, between the ribs.

I'd say choose the surgeon that you feel the most comfortable with, and let him choose which method is the best for your particular set of problems.

It is always possible that you might go into surgery with the thought of having minimally invasive, and it could develop into a sternum approach during surgery due to problems which could not be determined prior to surgery.

In things like this, its always best to have a flexible mindset. Nothing about this surgery is cast in stone.

 

[RCB]

Agree with Nancy

Agree with Nancy

Cooper,
The idea of going MI has been talked a lot by pts. when I had my last surgery and it was delayed for about a week. Many of the MI pts. seemed
to think it was more painfull, but healed quicker. One thing is for sure, MI does not give the surgeon the view that he gets with traditional method. If things get tough or tricky, all surgeon will go with the tried and true ways.
I am sure things will work out just fine- let us know!