Right Mini-Thoracotomy Mitral Valve Repair Next Monday!

[scg]

Scheduled for surgery at Duke next Monday morning. The hope is that they can perform the non-invasive procedure and fix the valve with Goretex chordae. Has anyone else had
this procedure successfully? Any complications? Any feedback would be greatly appreciated. Selecting a pig valve if they can't repair it.

51 year old male. "Tall & Skinny...typical candidate for this condition." says the Doc.
Severe Mitral Valve Regurgitation w/ EV of 50 - 65% with MVP. No symptoms recognized until murmur found during regular checkup in January 2012.
Thought I was just getting out of shape.
Otherwise good health competing as Triathlete up to 2009 and long distance cycling until December of last year.

 

[ejc61]

Mine was sort of similar. Went smoothly. I'm interested in the decision to go natural valve vs. mechanical if Plan B is used?

 

[scg]

EJC61 - I decided after talking to my regular doctor who deals with patients and the effects of going on anticoagulation drugs. From what I could tell it was a tossup with respect to risk. Tissue valves are lasting potentially as long as 17 years now, although I don't know what the average is. My decision was also based on several doctors saying that because of my age and lifestyle there is a very good possibility that I will have a life threatening injury due to the anti-coag drugs in the next 15-20 years. I would rather have the tissue valve and not be on those drugs...allowing me to continue to ride my bike and potentially compete again...albeit somewhat slower.

 

[scg]

I also replied below. What was your recovery like?

 

[ejc61]

That was the toughest decision re: valve. While I ski, cycle and kayak, I was told I should be fine doing my activities (with a mechanical ) as long as I wear a helmet, which I do for both, and not be wreckless. I guess the main difference is competing vs. just riding with my wife. If I recall from previous posts, you don't have any other issues.
My recovery was good. Repair done, out in 3 days. I was walking about 30 minutes a day 2nd day home. Road 10 miles on my bike on 1 month anniversary. The key is to just keep walking. Start walking in the hospital once they say it's ok. At about post op 18 hrs, I used the walker and covered a whopping 10 ft maybe in about 15 minutes. I was accompanied by hospital staff. It was just to get me moving. The first day outside ICU, I walked a few times until I got tired. I had my wife to walk with me. Once home, walk in your back yard and just walk in large circles so that you don't have to venture too far away. My nurse wife said its critical to walk as much as possible early on. Also, use the spirometer. Alot. It's not like you have anything else to do. I remember at post surgery 18 hrs, I was at 500 on the spirometer but was told that was pretty good. I drove in about 14 days. At 7 weeks, I did get a bout of pleural effusion which hurt more than the surgery by far. That was painful and was on/off for about 4 weeks. I never had any surgery before and I honestly said to myself that this wasn't so bad. I was 47 at the time. I was back at my desk job in 17 days. You seem to be in better shape than me. It'll go well. Relax and stay calm. It'll be good.

 

[Sarah_Louise]

Good luck for monday
Hope all goes well for you!
Love Sarah xx

 

[Luana]

Scheduled for surgery at Duke next Monday morning. The hope is that they can perform the non-invasive procedure and fix the valve with Goretex chordae. Has anyone else had
this procedure successfully? Any complications? Any feedback would be greatly appreciated. Selecting a pig valve if they can't repair it.

A thoracotomy is not a non-invasive procedure since an incision is made. Even a cardiac cath is an invasive procedure so it's impossible to have surgery that's non-invasive. Anything that gets inside you is invasive!

I had a mini-thoracotmy for an AVR. The incision is about 3 inches on the right side of my chest about 3 inches down from my collar bone; yours will probably be lower to get to the mitral valve.

The big advantage of this approach, usually called minimally invasive, is quicker healing and a quicker route to becoming independent. I could drive at 2 weeks post-op; sternotomy patients usually need 6 weeks. There was no need for me to sleep in a recliner or in bed with lots of pillows once home, as many sternotomy patients report.

I thought the pain was minimal. Because the incision is between the ribs, it's also going through muscle, and supposedly muscle hurts more when it's cut than bone. I have nothing to compare it to other than surgery in my lower back, which is also going through quite a bit of muscle, but I didn't think that was painful post-op either. There's little muscle over the sternum, so cutting it is thought to be less painful, though most after a sternotomy complain of back and neck pains for weeks after surgery. I had none with my approach.

I was very glad for the approach that I had. I would easily do it the same way again if needed.

Don't be surprised if the consent form you sign also asks consent for a sternotomy in case something occurs and thoracotomy approach can't be used. It was on mine. The surgeon can usually tell of the thoracotomy will work beforehand, but just in case, he may need another option.

You're young and in good health, which was pretty much what I was told before my AVR. You should do fine!

 

[scg]

My mistake saying non-invasive...meant less-invasive. Thanks for responding. All good to know. I guess build up of fluid is always a possibility post surgery...hence the chest tubes. To followup on my reasons for the tissue valve. My regular doctor was also a neighbor at my business so it was easy for me to go over and get checked out when something was wrong. Most of his patients are geriatric patients and he said he was constantly dealing with the long term side effects of anti-coagulants on his patients. My mother has also been on anti-coagulants and also has had a multitude of issues throughout her life. I try not to say "How are you Mom?" too often, because I'll always get an hour long play by play of every detail of her health condition which is never good. She has Afib and more than likely a similar condition to mine, but has never been diagnosed or tested for such. As for the potential for full sternotomy, I am resigned to the fact that it is a possibility and have set my schedule over the next 6 weeks as such. Figure if I plan on it, I will be pleasantly surprised if the thoracotomy is successful.

 

[ejc61]

I think you're making a good choice scg. Both surgeons I consulted with said there is usually no reason to go with the sternotomy as long as it's only a basic mitral valve issue. The heart cath and CT angio showed clear arteries for me so I was good to go. I think the first question out of my mouth once I had some conscienceness was "was it repaired"? My surgeon did use Gore-Tex for the repair. It was the more common posterior leaflet that needed repair, P2 segment to be exact, so he said it was fairly routine. I remember also being told to try to "keep to your routine" adjusted of course. In other words, don't sit around. I may have really pushed it however. The first morning at home, I got up at 7AM to feed my dogs under my wife's supervision. I had to take a nap by 11AM. That is expected and necessary I found. I think you will be pleasantly surprised.

 

[scg]

I can do naps! Sounds very similar to mine...got the impression P3 was the segment that was causing the trouble so not sure if that might be an issue. Surgeon didn't seem to think so. Same with the heart cath...all arteries clear. Not interested in sitting around. In fact I'm cleaning out the garage this morning...presurgery, and plan on using this fantastic day to take a 15 mile bike ride this afternoon. AND...as one of my nurses on a trip to the ER said that my heart murmur was "Wicked"...I thought it appropriate to get tickets to see WICKED the show tonight! Thanks ejc61!

 

[ejc61]

I wouldn't get too caught up with P1-P3. The surgeon told my wife specifically that posterior is more common. It take that to mean anterior is less common but I don't know the ramifications of that.
Since I was asymptomatic, I continued to do all my activities before surgery. What's important is that your body is being assaulted and somewhat bloated with "stuff". Walking gets everything out faster. (Dumbed down for me). The surgeon also said that your heart recovers from the trauma in only several hours.

 

[scg]

"The surgeon also said that your heart recovers from the trauma in only several hours."
That's amazing...I never knew that. I always thought that it would take as long as any other injury, but I guess the blood flow is at it's highest right there.

 

[ejc61]

It was explained to me that this is why going as minimal as possible is important, when appropriate of course. You don't have months of sternum recovery. I was told that maybe 15-20 years ago, they would do nothing for our case until further problems came along at would then warrant a sternotomy. In the meantime, we would be given meds.

 

[Jkm7]

A thoracotomy is not a non-invasive procedure since an incision is made. Even a cardiac cath is an invasive procedure so it's impossible to have surgery that's non-invasive. Anything that gets inside you is invasive!

I had a mini-thoracotmy for an AVR. The incision is about 3 inches on the right side of my chest about 3 inches down from my collar bone; yours will probably be lower to get to the mitral valve.

The big advantage of this approach, usually called minimally invasive, is quicker healing and a quicker route to becoming independent. I could drive at 2 weeks post-op; sternotomy patients usually need 6 weeks. There was no need for me to sleep in a recliner or in bed with lots of pillows once home, as many sternotomy patients report.

I thought the pain was minimal. Because the incision is between the ribs, it's also going through muscle, and supposedly muscle hurts more when it's cut than bone. I have nothing to compare it to other than surgery in my lower back, which is also going through quite a bit of muscle, but I didn't think that was painful post-op either. There's little muscle over the sternum, so cutting it is thought to be less painful, though most after a sternotomy complain of back and neck pains for weeks after surgery. I had none with my approach.

I was very glad for the approach that I had. I would easily do it the same way again if needed.

Don't be surprised if the consent form you sign also asks consent for a sternotomy in case something occurs and thoracotomy approach can't be used. It was on mine. The surgeon can usually tell of the thoracotomy will work beforehand, but just in case, he may need another option.

You're young and in good health, which was pretty much what I was told before my AVR. You should do fine!

I had two sternotomies and slept in my bed (with pillows for about 2 weeks) from first night home, was driving in 2 1/2 weeks post op my second surgery and was walking 1 1/2 - 2 miles daily in under three weeks.

My Mass General surgeon tried hard to repair my Mitral Valve, obviously a hugely skilled and experienced surgeon to be at MGH, but in the end he replaced it with my choice which was tissue valve.

For me, it was absolutely the best choice but, of course, not for everyone.

 

[catwoman]

My husband had MV repair nearly 5 years ago, at age 61. He had a thoracotomy, done by Dr. William Ryan at Dallas Presbyeterian Hospital. One or more chordae had ruptured during a car accident in December 2005 when the airbag went off, fracturing his sternum. He had already dealt with sternum pain, had seen me go through my MVR in 2003 and seen his dad through 2 heart surgeries, so was interested in a thoracotomy.

He had lymphedema as a minor complication of the procedure -- there was a catheterization in his left groin that injured a lymph node and caused his left leg to swell. It took several months for it to resolve. Our PCP did have it ultrasounded to rule out a clot, and apparently the only thing you can do for lymphedema is to give it time to dissipate.
He also developed an arrhythmia while in the hospital. I was in the room, when he said his heart felt odd. The nurses came in and confirmed what was going on. His surgeon first gave amiodarone -- which did nothing. What should have been a 3- to 4-day hospitalization turned into 7 days. He went home on warfarin to prevent clots from the arrhythmia. He was on it for 7 months, until December 2007. Because I have been on warfarin since 6/24/03 and home-test, he wasn't concerned about being on warfarin. The arrhythmia finally resolved.

I've heard nurses say that the thoracotomy is more painful than a sternotomy. That would be difficult to quantify, since pain is very subjective. Some pain is mental, some physical.
My husband is a Grade A Wuss (good thing he wasn't born a woman!). However, he had little pain or discomfort from the thoracotomy incision. And I would consider one in a heartbeat (sorry for the pun) if I ever face OHS again and if it's appropriate for the procedure.
NOTE: My husband's recovery was significantly shorter than mine.

Good luck with your surgery. I am sure you'll fly through recovery.

 

[Bryan B]

scg,

I just wanted to wish you well on Monday from a fellow Triangle resident and someone who has had 2 heart surgeries at Duke. They will take good care of you. Just out of curiosity who is your surgeon?

 

[scg]

scg,

I just wanted to wish you well on Monday from a fellow Triangle resident and someone who has had 2 heart surgeries at Duke. They will take good care of you. Just out of curiosity who is your surgeon?

Don Glower. Thanks for the well wishes.

 

[scg]

All good info! Right now not nervous at all. Just want it over with. Intrigued by the fact that your husbands condition caused by air bag. I fell on my back really hard about 10 years ago and then fell off my bike last year. Was hardly moving. Stood up on my pedals from a stopped position on my road bike and hit a slick spot. The bike just went out from under me. More concerned about my head hitting the deck. Not long after last years fall I started having symptoms but didn't make the connection until after diagnosis in January and subsequent discussions. Who knows if the earlier fall might have set the wheels in motion or not. Will never know I guess.
Today I occupy my mind and time with chores.

 

[ejc61]

scg
Something else I thought about. Don't be alarmed when you get home at you've gained 10 lbs. It'll come off in about 3-5 days on its own. My surgeon also said to make sure I eat a nice big steak. I think he was trying to calm my nerves. I did eat more red meat the few days leading up but I don't know if that really matters.

 

[catwoman]

Motorvehicular accidents can cause deceleration trauma, injuring the heart. Your body is going forward at a high rate of speed and it's like hitting a wall when you have a crash. A friend's SIL died due to aorta rupturing when airbag went off.
There's a wealth of research online about cardiac injuries resulting from deceleration trauma.

Your fall sounds pretty frightening!

Good luck with your surgery. Fast-forward your mind to the good times ahead, when you are 100% through recovery!