Open heart surgery and redo operations

[Meanjellybean]

Hi all,

I was hoping to get you experience with OHS and specifically the difference if you have required to have a reoperation.

I have had 3 sternoctomy (2 , 3 and 20 years of age). I am due for my 4th at 31 years old but have had mutiple delays due to hospital ICU and emergency patients.

My re-operation when at 20 years old was rather uneventful and i am truely grateful. I was in ICU for 2 days and after 2 days on the ward i was sent home fot the rest of my recovery. I do believe that the gap between my surgeries and how the body continued to grow and form was to my advantage.

However, i know this is not normally the case and usually with a reoperation there are higher risks for example:
- scar tissue - longer operation and difficulty for surgery
- higher risk of bleeding and then the flip sidr of higher risk of clotting (stroke)
- bone issues and its reconnection not as stable and able.
- pace maker requirements (nerve fibres cut several times leading to Afib or heart block symptoms).

And the list goes on..

What was your experiences with surgery vrs redo.
I do want to believe that my surgery will be like my one 11 years old but i do not want to be ignorant as i know that its not the same.

Thanks VR community inadvance.

 

[Meanjellybean]

The ‘cardiac surgical paradox’, however, remains true: the higher the risk of surgery, the more an individual patient stands to gain from the procedure. It is vital, therefore, that surgeons are not penalised for being prepared to take on these high risk patients.

I found the quote above in a journal article and wanted to share.

 

[pellicle]

What was your experiences with surgery vrs redo

probably not helpful, because surgery was 10yo, however 2 redos. Last Redo was at 42 and it went "unremarkably" from the terms of healing

HTH

 

[pellicle]

: the higher the risk of surgery, the more an individual patient stands to gain from the procedure

bizzare ... I stood to gain more life at 10, I stood to gain the same at 42 (less really, because at 10 I was given the rest of my life, but by 42 I'd lived a large portion of it already

 

[Meanjellybean]

bizzare ... I stood to gain more life at 10, I stood to gain the same at 42 (less really, because at 10 I was given the rest of my life, but by 42 I'd lived a large portion of it already

The article in context of the quote was based on the reasoning for redo vrs doing nothing as well as considering emergency cases in which the mortality rate is generally 100%. So not so much in the context of when surgery was benefical to a patient in life cycles.

 

[Meanjellybean]

probably not helpful, because surgery was 10yo, however 2 redos. Last Redo was at 42 and it went "unremarkably" from the terms of healing

HTH

Thats awesome to hear it was unremarkable. I gather the longer apart the surgeries the better.

Redo Valve Surgery - what we have learned

Shows a few pictures (trigger warning) of what a surgeon is presented with regarding a OHS and Redo OHS. The surgeons skill and expertise is a key factor in redo ops 100%.

 

[pellicle]

surgeons skill and expertise is a key factor in redo ops 100%

I'm sure they want you to believe that, but proper medical imaging and planing before surgery is actually crucial too...

 

[pellicle]

Maybe come to Queensland for your surgery?

 

[Superman]

I was on the table longer. My wife was there and able to tell me a lot of how things went. It took a long time to saw through the sternum a second time. Also, the cardiac muscle can adhere to the sternum a bit during healing from earlier rounds, so they have to be careful. I was on the table for around eight hours, but most of that time was opening and closing. My heart wasn’t stopped for any unusual amount of time.

Fortunately I didn’t need blood either time and was able to recover on my own. Recovery time the second time around I chalk up to being 19 years older and not in great shape. But it wasn’t a nightmare by any stretch. No rehospitalization or anything.

 

[Meanjellybean]

Maybe come to Queensland for your surgery?

Yeah, a trip to queensland wouldnt be a bad idea, if the premier was not locking the boarder every second day!

I was asked to come to hospital on the monday for admission for surgery on Tuesday this week.
When we get there they say that they need a Bed and tell me ti hang around. We after waiting for 3 hours i start to ask more pressing questions only to be told that they changed the surgery to thursday and to go home. Total waste of a day.

Then after multiple phone calls on wednesday the cancel me till next week.
Welp.. one good thing i can see out of the delays is that if you are in need of a ICU bed they wont kick you out, but delay others so that you can stay where your care is needed.

 

[Meanjellybean]

I was on the table longer. My wife was there and able to tell me a lot of how things went. It took a long time to saw through the sternum a second time. Also, the cardiac muscle can adhere to the sternum a bit during healing from earlier rounds, so they have to be careful. I was on the table for around eight hours, but most of that time was opening and closing. My heart wasn’t stopped for any unusual amount of time.

Fortunately I didn’t need blood either time and was able to recover on my own. Recovery time the second time around I chalk up to being 19 years older and not in great shape. But it wasn’t a nightmare by any stretch. No rehospitalization or anything.

That sounds pretty decent. You were 19 years old first time around? And had second surgery at 38? That mean you had sternal wires that needed to be cut through the second?

 

[Superman]

That sounds pretty decent. You were 19 years old first time around? And had second surgery at 38? That mean you had sternal wires that needed to be cut through the second?

17 and 36, but close enough. Yes, sternal wires.

 

[Chuck C]

Hi Meanjellybean,
I've only had one OHS, so I can't speak from experience on the multiple surgeries. However, you may find this study interesting, in which they look at statistical mortalities for multiple OHS, taking it all the way out to the 7th procedure. Yes, the mortality rate does increase, but I find it remarkable how small the incremental increase is between surgeries. Also interesting is the J shape of the mortality graph(see figure 1), with the risk dropping from 1 to 2 and again from 2 to 3. The 3rd procedure is the low point of the mortality, before it starts to consistently increase with each procedure. Of course this type of study has many limitations, but I think it is encouraging that, from a statistical standpoint, the incremental increased risk between the 3rd and 4th procedure is very low, some would say insignificant.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276147/

 

[pellicle]

Yeah, a trip to queensland wouldnt be a bad idea, if the premier was not locking the boarder every second day!

She's a dipshit that's for sure ...

also I've posted that stenal wires and discussed it a lot here, sorry if you hadn't seen it.

check that image larger, what appears to be "double image" is not, its remaining wires. In some cases that's 2 prior surgeries (and staples) you see in there.

You will NOT want a sternal infection as I had and IF the other wires of mine had got infected (the deeper old ones) then they'd be cutting my sternum out and I'd be going without that. We did have until a few years back a fellow here who had that exact problem. Perhaps it adds weight to my darker attituded in my post on "surgical complications"

The thing is that in Australia everyone is going to have sternal wires (I've not heard of a single venture into the Talons or other closures). The wires might dislodge when yanked hard enough but they normally just cut around the bone to expose them and then I would expect they use side cutters once they've exposed of them. One does not want iron filings in the wound.

They will get solidly embedded in bone as you see in mine.

 

[Superman]

I just tell folks that I’m held together with bread ties.

 

[Meanjellybean]

She's a dipshit that's for sure ...

also I've posted that stenal wires and discussed it a lot here, sorry if you hadn't seen it.

check that image larger, what appears to be "double image" is not, its remaining wires. In some cases that's 2 prior surgeries (and staples) you see in there.

You will NOT want a sternal infection as I had and IF the other wires of mine had got infected (the deeper old ones) then they'd be cutting my sternum out and I'd be going without that. We did have until a few years back a fellow here who had that exact problem. Perhaps it adds weight to my darker attituded in my post on "surgical complications"

The thing is that in Australia everyone is going to have sternal wires (I've not heard of a single venture into the Talons or other closures). The wires might dislodge when yanked hard enough but they normally just cut around the bone to expose them and then I would expect they use side cutters once they've exposed of them. One does not want iron filings in the wound.

They will get solidly embedded in bone as you see in mine.

They left the wires in? I didnt think that was a thing they would do. As long as it doesnt cause issues i guess.. or taking them out of bone could be more risky.

I did see your post about your sternum issue. Looked very swollen and pus filled.
Ill have a look for the other post -
surgical complications"

only sternal wires are used in Australia, why?
Have you ever had a sternal wire break?
I have my bottom sternal wire break 2 years ago. It felt like a broken rib and swelled up badly but nothing came of it.
I now use it as a quiz for the students who do imaging scans to see of they can see the broken wire.

 

[pellicle]

or taking them out of bone could be more risky.

as I said, the bone attaches to the wire over time ... have you ever done any gardening with plants that grow up sides of houses? Organisms do a very good job of immobilising things.

The problems only come when a deeply embedded bit of stuff (wire say) gets exposed and infected ... once its all stitched up and inside then as long as nothing grows (MRSA, Propi ...) you're home and hosed as the Immune system will kill anything and nothing will be able to penetrate (unless you do some sword fighting such as fencing or duelling ... or get shot ...).

only sternal wires are used in Australia, why?

Probably because

1. they're well known
2. they work
3. they don't cause significant problems
4. they can be removed (if not left in for decades suggesting they didn't cause problems)

Surgeons are conservative not just by nature but by law.

Have you ever had a sternal wire break?

Me? no ... but note the blanket stitch on the middle of the (bigger bone of) the sternum? That's what my surgeon likes to do.

I have my bottom sternal wire break 2 years ago. It felt like a broken rib and swelled up badly but nothing came of it.

wow ... a bottom one ...
Was there some "event" associated with that?
Did it break or unravel?
did it look as large a guage as my current ones or smaller like the older ones present.

I'm expecting that the older ones are from the 1992 surgery and they'd have pulled the 1974 surgery ones then ... or most of them.

 

[pellicle]

I just tell folks that I’m held together with bread ties.

our bread ties are plastic now :-(

 

[MdaPA]

check that image larger, what appears to be "double image" is not, its remaining wires.

pellicle,
If you have some of the remaining sternal wires from past surgeries, then how did they open your chest for your last surgery? Did they just snip them to spread your chest open but leave them there? I'm no expert at reading images but I don't see where the extra wire was snipped. Also, in the "double image", it sure seems to have the same twists and follow the same path around the bone as the other wire.

 

[Meanjellybean]

I though he was referring to the lighter and finer lines.. not the doubled up..