Port Access

[Raylock]

Good morning. I just found this group and have been reading many of the posts. Obviously, the members constitute a large body of experience and knowledge. I have been told that I will need an AVR within the next year. I have been reading about miniminally invasive surgery. The most interesting type seems to be the port access method. Two surgeons with which I have had preliminary telephone discussions have suggested that I will find that this procedure is no longer as popular as it once was. Has anyone here received an AVR or other procedure using the port access method or is there anyone who has opinions on this procedure?

Thanks
Ray

 

[Nancy]

Hi Ray-

My husband had his mitral valve repaired with the Heart Port method. It was his third valve surgery and going through the sternum again was a little problematical because of scar tissue.

That method means having to go through the lung area with one of the instruments and then going from the groin area up to the heart using a cannula to thread another instrument. It's tricky and I think a slow go with the cannula. I wouldn't say it saved any time, and may have even been a little slower than an ordinary procedure through the sternum. Your vascular system has to be in good shape. The recovery period is better by about one day, as far as I can tell. The pain is about the same because you also will have lung pain which can be quite nasty. Your lungs have to be able to withstand it also.

It was fine for my husband's repair which was a small one, 2 stitches, and gave a good view of that surgical site, however, I'm not sure all procedures would work out quite as well with this procedure.

I would listen to your surgeon on what is best for you. He's the guy who's the expert and he knows just how much room he needs to do whatever he has to do to you. Not every procedure is the same. There are others here who've had a minimal sternum procedure as well. I'm sure they'll address that with you.

By the way, welcome to this terrific site. As you already know, there's a ton of info. here with all kinds of experiences.

Hope to see you here often.

 

[hensylee]

My cousin's granddaughter had a hole in her heart fixed via minimal invasion - not valve replacement, tho. I asked her to send me particulars and here they are:

Now to your inquiry: Kellie had a hole in one of the chambers of her heart. Seems to me it was a ventricle. But I'm not sure. The doctors went up through her groin to the place that needed repair and fixed it by putting a patch over it and sealing it via laser. She's been fine ever since. This is a pretty new procedure, in lieu of open heart surgery, and very much less invasive. Her insurance company was hesitating because it was new. Her heart doctor's husband(also a heart specialist) had pioneered on the procedure at some big hospital like Mayo Clinic or Johns Hopkins. Her doctor invited Kellie and Spence over to her house to meet and talk to him, which they did. It convinced them it was a better procedure. Spence(Kellie's husband) is a podiatry surgeon so he understood all the medical jargon. That's why Kellie nagged her insurance company to schedule the procedure. She threatened them with going to the newspapers and TV stations. Within the hour, they had scheduled her procedure for the next day, a Thursday. She went back to work on Monday. Incidentally, open-heart surgery costs at least $50,000 and the laser procedure $25,000. The procedure is very similar to a catherization.
Hope this information helps whoever it is who needs it. We, of course, don't know them but they will be in our prayers. God knows who they are.

 

[Raylock]

Thanks for your responses. It appears that the Port-Access method is not a highly used procedure. An article on the procedure can be found at www.med.nyu.edu/hcsolutions/minim/minim.html
If it can be done in my case it sounds like it might be an attractive alternative to the normal procedure. I'm still in the early research mode. Again thanks for your comments.

Ray

 

[DuchessBear]

Hi Raylock

I've been "lurking" on this site for a while, but your message finally prodded me to register, especially since there have been so few responses to your inquiry.

My advice on minimally invasive surgery is that if it is an option, go for it! But as Nancy indicated, your surgeon must be comfortable with and skilled at the procedure. I am fortunate to live close to a heart center with a lot of experience with HeartPort surgery -- I'm only 3 miles from Inova Fairfax Hospital in Northern Virginia. I had my mitral valve replaced (St.Jude's bileaflet, Oct 2001) through a 3 inch horizontal incision just under my right breast. The surgeon went between the ribs (no cutting of any bone) and into the heart through the back side. A small incision in my left groin is where they hooked up the heart-lung machine. I did not experience anywhere near the pain or discomfort described by others on this forum. Mostly it was muscle-type pain in the area of the chest incision -- the groin incision never bothered me at all, and I had no problems with my lungs. I took an occasional Percocet for about the first 10 days and an occasional Tylenol for about a week after that. I had very few restrictions on activity. I could do pretty much whatever I could tolerate. I was driving at about 2 1/2 weeks post-op and in rehab at 4 weeks. One thing that's going to be the same for any type of surgery is the total recovery time. It still takes a while for your stamina to get back to normal, but I am so glad I didn't also have to deal with wires and healing bones and other issues associated with traditional open chest surgery.

Here's a few web sites with good information: www.inova.org, www.heartport.com, www.ismics.org (International Society for Minimally Invasive Cardiac Surgery), www.sts.org (Society of Thoracic Surgeons), www.nhlbi.nih.gov (National Heart, Lung and Blood Institute).

 

[Marty]

Port Access, anyone?

Port Access, anyone?

Hi Duchess, I live in McLean and had a mitral valve replacement at Inova in September 1998. Prior to surgery I asked my cardiologist
his opinion of port access and he said no thanks if it was him going under the knife. He wants his surgeon to be comfortable and have plenty of "exposure". So they did do the sternum split on me and surprisingly I had almost no discomfort, no infection, and no wire problems. The incision is now barely visible. Just lucky I guess.

 

[Raylock]

Hi Dutchess, thanks for the reply.

It looks like this is one of those procedures where the physician thinks that his/her method is best. The HeartPort method is a new procedure having been developed only in the last five or six years. Consequently most surgeons are not personally familiar with the process. I have found a few surgeons that are using this procedure almost exclusively (absent medical situations which would preclude it). I am probably leaning toward using a surgeon/facility highly experienced in the HeartPort process when the time comes. Fortunately, I have time to do some research and hopefully make an informed decision. Thanks again for your input. It sounds like your experience was a positive one.

Best
Raylock

 

[gary]

Duchess Bear, thanks for volunteering your information

Duchess Bear, thanks for volunteering your information

Can you provide any specifics?

Total time on pump, clamp, duration of operation?

Age, weight, conditioning, leakage, MVP, other medical problems?

The few stories I've read in the last three years have been glowing if the heart port surgery is performed by the right team.

The Mitral valve is certainly more complicated than the Aortic and the entry thru the back of the heart is fascinating.

Any A-fib events that it seems a lot of Mitral valve recipients experience?

Thank you for any further info.



AVR: 4/00; cosgrove; CCF.

 

[John Cochran]

Gary,
I seriously persued a port access option for my AVR. I ended up getting a mini-sternotomy instead. The deciding factors were as follows:

-My surgeon, who had done a lot of port access surgeries, explained how a balloon occluder is used (fed up by catheter from a groin incision) to block off blood flow during surgery. He explained that the balloon can be cut or "pop" during surgery, in which case you get a FAST full sternotomy;

-The needed groin incision can affect your ability to walk right after surgery, which is a critical time to get up and around.

My mini-sternotomy left some strength in the sternum, and I think I recovered "structurally" faster than for a full sternotomy.

If you do opt for the port access, just make sure the surgical team has TONS of experience with it.

Best,
--John

 

[DuchessBear]

Gary --

Inova Fairfax Hospital started doing HeartPort surgery in 1997. 5 years is a long time in the medical/technology world, and I'm surprised more surgeons haven't updated their skills with the HeartPort or other minimally invasive techniques.

Not everyone is a candidate for the HeartPort procedure, however. Various conditions could dictate the sternotomy approach. If my catheterization had shown any other problems, I probably wouldn't have had the HeartPort option. But when offered the choice, I didn't hesitate for even a second, and I have absolutely no regrets.

To answer your questions:

Total time on pump, clamp, duration of operation?

I keep forgetting to ask about the specific numbers, but it was all pretty much average for that type of surgery. That it was a HeartPort procedure didn't make much difference one way or the other.

Age, weight, conditioning, leakage, MVP, other medical problems?

I was 56 at the time of surgery, average height and weight, and fairly fit (half-hour workout 4-5 times a week). I didn't have any medical problems other than the bad mitral valve, which was the result of rheumatic fever when I was about age 5. I had a murmur but was pretty much asymptomatic until June 2001, when I went into CHF. An echo showed prolapse and considerable enlargement and increased regurgitation since the previous echo only 2 months before.

Entry thru the back of the heart

From what I've been told and what I've read, for the mitral valve, going in through the back of the heart actually gives the surgeon a better view. Besides a video scope, they also use a TEE throughout the procedure.

Any A-fib events that it seems a lot of mitral valve recipients experience?

I had occasional afib in the months before surgery, and it became chronic afterward. I had cardioversion in January 2002 (3 months post-op) and have been in normal sinus rhythm since then. I take 160mg of sotalol twice a day to help keep it that way.

You can probably tell that I have been pleased with my treatment. Of course, I wish I'd never had to go through all this at all!