Open Heart vs Minimal Invasive

[rubywhistle]

I am pre-op (mitral valve repair or replacment) and would like to know about your experiences with open heart and minimal invasive - if you or your surgeon choose - and why. It would be great to get the perspectives on the differences for recovery and if you were told there were different risks.

Thanks

 

[sensei Ade]

Hi Ruby,
My first operation to replace my aortic valve was a mini sternotomy and my second operation to have it changed again last year was a full sternotomy. Recovery from this is a long old process. It takes 3 - 4 months recovery from the surgery and then about another year to 18 months for your heart to remodel to the new valve and stabilize. Once you've got through the first couple of weeeks things are much better after that. The recovery time hasn't really been any different for each type of surgery, the only difference is that with a mini sternotomy you have less scarring, that's all. Yes, the new percutaneous valve replacements are all the rage right now, but it's early days with these yet as there are question marks over their durability and risk of stroke. I've had open heart surgery but at least I now have an On-X valve that is designed to last 100 years +...this is all food for thought for you.

Take care

Sensei

I am pre-op (mitral valve repair or replacment) and would like to know about your experiences with open heart and minimal invasive - if you or your surgeon choose - and why. It would be great to get the perspectives on the differences for recovery and if you were told there were different risks.

Thanks

 

[Cooker]

This may be a very simplistic way of looking at it but my thoughts were that with my AVR I wanted the surgeon to have as much room to work as possible, if something went wrong or problems were encountered during a minimally invasive surgery I believe they might have to open me up fully anyway ... I did not find my recovery to be much different from those reporting their experience with minimally invasive but having what I hope is my one and only heart surgery I don't have a personal comparison to share...

 

[Luana]

I asked my surgeon about a minimally invasive approach, an incision between 2 ribs, no sternotomy, because I did not want to have my sternum broken. Turned out I was a candidate for this approach and that's how my surgery was done.

I don't consider a smaller sternotomy as less invasive, as the bone is still broken; you just have a smaller incision. Because I live alone, the incision I had allowed me to drive 2 weeks after surgery, and I had no problems getting out of bed as people with any size sternotomy frequently have. For me it worked out well.

If the surgeon needed more room, by all means he could have gone for it. The consent form I signed said a sternotomy might need to be done if the port access (small thoracotmy) did not work.

 

[Jkm7]

Both methods of opening access to the heart are Open Heart Surgery. It is just one is more minimally invasive.
I left the choice to my surgeon though we did discuss both. In the end, we decided for my second OHS to fully open the chest.... a full sternotomy.

Open heart means the heart is opened.
If I understand your question, I think you are asking whether one would want a full sternotomy vs. a minimally invasive opening. Is that what you mean?

 

[escargome]

I went with full sternotomy. I wanted that surgeon to be able to see everything and have room for his hands. If and when the need arises I will still choose the same method for the same reason.

 

[piglet]

I wasn't given a choice, and in a way I'm glad. I had the full sternotomy to replace my aortic valve. I had endocarditis that the surgeon said he almost missed. Would he have found it with a less invasive proceedure? We'll never know.

 

[Bina]

Mine was the full deal.....surgeon wanted a good look and access to my dilated aorta root if needed.

 

[ElectLive]

This is a tough one, but I'll stick with what I did and say full sternotomy, for now.

My surgeon told me that he does perform minimally invasive procedures but that it doesn't give good exposure and compromises the operation to a degree. According to the national data, he said there has been double the risk of surgical stroke. The problem had to do with getting all the air out of the heart, which is harder with limited access, and that air can in turn go to the head. This is my translation obviously, so forgive me if I'm a little "off", but from a non medical point of view, that's what I remember.

Now, Cleveland Clinic says minimally invasive sternotomy (6 cm ~ 2 1/2 in) is now standard for aortic valve replacement, they only use a full sternotomy for more difficult cases. They also say that in experienced hands the operative risk is slightly lower.

So, if I were going to Cleveland for example, I'm sure I'd feel more comfortable going minimally invasive, but probably still wouldn't do so unless I had complete confidence from the surgeon that they weren't sacrificing anything using that approach, not even a small percentage of additional risk.

 

[ElectLive]

I am pre-op (mitral valve repair or replacment)

Sorry, missed that you were mitral valve before my post. Minimally invasive is different for mitral vs aortic, so some aortic valve answers here may not directly apply.

 

[Mentu]

Ruby, welcome to VR. As some of the others have done, I wanted my surgeon to have every advantage when it came time for him to work on my heart. (And if you saw the size of his hands!) I didn't want to consider anything that might decrease the risk of my full recovery. Yes, the sternotomy leaves a scar but it usually fades and isn't very intrusive. With time one can even become sort of fond of it. It also is a reminder that life is uncertain and should be enjoyed to the fullest in the new future that comes with recovery. My vote is for whatever will insure the best outcome for you.

Larry

 

[JulieS]

I went to one of the best surgeons in the country and left it totally up to him as I wanted the best outcome - I did not know that there was a choice. I would say as long as you trust your surgeon and he/she has done alot of them and has a very good track record then talk to him about it and make your descision accordingly. Best wishes!

 

[hook]

going through the ribs can cause nerve damage and irritate breast tissue.

 

[ejc61]

I think there's a big difference between the handling of a MV and an AV. A patient has several tried an true options for MV repair/replace. Not as many options for AV.

 

[LeakyUK]

I had full opening for AV (No choice). I was walking to the bathroom after 2 days and home in 5. I felt OK at 2 weeks and much better at 4. No driving until week 7. I slept in bed in a raised position, getting in and out of bed was awkward and painful for the first few days. Overall I was surprised by how quickly I recovered.

 

[Greg a]

Ruby, I just want to WELCOME YOU TO THE FAMILY as I have no sternum I cannot contribute to this thread but in the overll scope it is MANDATORY that TWO people are happy and comfortable wit the choice YOU AND YOUR SURGEON

 

[Luana]

going through the ribs can cause nerve damage and irritate breast tissue.

My incision was well above the breast; it's about 3 inches down from the collar bone, and I have had no nerve or tissue damage.

 

[skrzyp]

I just had a minimally invasive MV repair in mid-July. I have had some neuralgia around the sites of both incisions (groin & chest), but it is fading with time.

I asked my surgeon specifically about whether the minimally invasive approach was more difficult for him compared to the full sternum access, and he said they were about the same difficulty from his perspective. He estimated 20 minutes longer to do the min. inv., and that's how it worked out. Also, he said that it may be necessary to switch to the normal procedure if he judged that the min. inv. approach wouldn't work out. (I think it depends on factors such as body size, repair feasibility, etc.).

The benefit for me is that I was out of the hospital in 2 days, and walking extensively the first week after surgery. At 5 weeks out, I am working again and doing really active physical rehab 3 times/week. The key issue is to follow rehab instructions and procedures very carefully.

I'm new to the forum today, and will post some details about my case soon.

 

[rubywhistle]

By minimal invasion I believe what my surgeon is talking about sounds like your op skrzyp and luana- with the incisions in ribs and groin. I find out on Thursday if this is a possibility for my op when I have the transophegal echo and cardiac MRI. Australia is aparently leading in this kind of op and my surgeon was recomended as he performs it but they always go standard sterunum route if anything looks tricky. I have heard of some of the risks others menitoned here - higher risk of stroke my surgeon said it was 1.5 % higher based on data from USA so - but did I not know it was due to air getting caught really interesting thanks ElectLIVE.

 

[skrzyp]

Sounds like your going with an experienced team, so I would think you'd want to follow your surgeon's recommendation for your case. I wouldn't get too concerned about the various risk estimates comparing procedures. These tend to be very study and population-dependent, are typically based on studies using small numbers of patients with limited follow-up, and don't necessarily account for important factors like surgeon experience, patient age, pre-existing conditions, etc. The fact that your surgeon is aware of the latest research indicates that you're in good hands. All the best for a fast recovery!