Robotic MVR on 11/22

[trudibeth77]

Hi! I am new here - but have been reading the very helpful comments on this forum for weeks. I am 36 years old and scheduled to have mitral valve repair with Dr. Doug Murphy at St. Joseph's in Atlanta on the 22nd. I am actually flying up from Sarasota, FL to have the surgery, so that I can avoid full OHS locally. I was diagnosed with MV Prolapse, with moderate to severe regurgitation. I am also having PVC's very regularly (like every other beat). The regular echo showed my left atrium slightly enlarged, but the TEE did not (I believe). However, immediately after the TEE, they performed a second [external] echo, and the atrium showed enlarged again. Nonetheless, my cardiologist felt it was time for surgery- the sooner the better. I consulted with a surgeon locally who agreed I should have surgery ASAP- though he would do full OHS. He gave me a 75-80% repair rate (I have bileaflet disease). I also got a referral to Dr. Murphy in Atlanta. He was wonderful to speak with over the phone- he said his repair rate is 98-99%. He also stated he does not do the robotic method because the recovery is easier or because it is aesthetically more pleasing, BUT because he feels he accomplishes the repair equally as successful as OHS with lower risks that way. Also, he feels the view of the valve is better from the side. At any rate, I know there is some debate as to the best method, but I feel this is the best route for me. I am flying up to Atlanta this Wednesday for 2 days of pre-op testing, with the surgery on Friday. I have lots of family within 2 hours north of Atlanta who will come stay with me during the surgery and I'll also be able to recover at my Dad's house through the Thanksgiving holiday, before making the 10 hour car ride back to Sarasota. My husband and two young kids will be driving up 2 days after the surgery, because I know my kids will be bored hanging out in a hospital room and will probably drive me bananas when I know I should be relaxing.

Can anyone who has had the robotic procedure give me an idea what I should expect before, during and after? I'm the world's biggest baby, so I'm mostly concerned with pain. I can deal with some tenderness and discomfort, but I don't like pain. I get stressed just thinking about the IV's (hate them!). I've had two c-sections, so I'm not sure how this will compare. It sounds like a big part of the recovery is dealing with the aftermath of the anesthesia (which was not as big of a deal with the c-sections because I was not knocked all the way out). Also worried about all the tubes, etc- the thought really grosses me out. I'm really squeamish. I know I'm going to have to get over it- so I'm hoping to arm myself with as much information beforehand so there are very few surprises.

Thank you for your help!!!!!
-Trudy

 

[knotguilty]

Hi Trudy and welcome. First, I can not say anything about the robotic procedure. I didn't think they did that on young people. You may be having what they call a mini surgery where they make a small incision at the top of your right breast and go in that way as compared to splitting your sternum open. I had the mini AVR. But, don't worry about pain. They have really good meds to take care of that. Personally I had very little to no pain. The tubes will be the least of your concerns, but they all come out pretty easy and they put them in when you are out. The surgery is nothing like I thought it would be other than it does take a lot out of you and you will be moving kind of slow at first. Recovery was amazingly fast. I had to force myself to take it slow. As far as anesthesia, I had asked them to keep me out to just before they are ready to pull the breathing tube out, which they did. I woke to them saying to take a deep breath and blow the tube out. So I have very little recollection of the tube. If I had to do it again, I would ask the same thing, because I did throw up twice because of anesthesia in ICU and I wondered what would have happened if I had had the tube still in me when that happened. You can find all kinds of experiences on this web site. They say they are repairing your valve, is there a backup plan if it has to be replaced? I hope all goes well with you. Please let us know how you make out. You will be in my thoughts and prayers.

 

[trudibeth77]

Thank you for your reply! Yes, they are making 4-5 small (cm-sized) incisions around the right breast (or "stab wounds", as the surgeon so aptly described them) for placement of the robotic instruments, tubes, etc. My cardiologist initially recommended the robotic procedure BECAUSE of my young age. I really appreciate the advice on the breathing tube- I would have never even thought about that (vomiting from anesthesia with breathing tube in-- YIKES!). The thought of a breathing tube down my throat is pretty unsettling, but hopefully I'll be out of it enough that it will be a nonissue. I was told the backup plan for replacement would be a mechanical valve, given my age. I still have a face-to-face consult with the surgeon on Wednesday, before my surgery, and I will get more detail then. Honestly, I think I would prefer a tissue valve, despite my young age. But the two surgeons I have spoken with both said they would replace with a mechanical valve (no option given to me). Again, that's one of my questions I want to ask at the face-to-face consult.

Your reply has been most helpful- thank you again!

 

[Midpack]

Robotic MVR on 11/22

Hi!
Regarding the replacement option, if repairs fails (but it will not fail!!), i was also told that mechanical is the option. It seems that tissue valves are not so often used in mitral position, at least in young patients.

Good luck!
You will be fine!

 

[Trixie]

I had mitral valve repair in 2012 and was recently told I now have moderate to moderately severe regurgitation. Needless to say I am not happy . Has anyone else had this experience? Feeling unlucky

 

[chaidell]

Hey Trudy, I'm also having bileaflet mvr, but via OHS, tomorrow:eek2:.

I don't want to scare you, but I thought it would be a disservice to not let you know about my experience.

I live in Atlanta and originally wanted to go with the robotic approach for obvious reasons. However, my cardio, who recommended Robotic to his patients in the past, now recommends either the Mini T or OHS only. His reasoning is due to the number of Robotic repair patients coming back with moderate regurgitation after 2 years (I even believe there is someone on this site that can come forward). From what I understand, the lack of tactile feedback using the robotic approach makes sewing in the annulus ring very difficult, causing it to loosen over time. Since the mitral valve pumping action is quite strong, you want to make sure that ring is very tightly sewn in.

With that being said, bileaflet repair is complex, and the ring is an extremely important part of a successful repair. Those who have less complicated repairs like the posterior leaflet resection, may get away with a minimal approach, but I would not risk a durable repair for less initial pain.

Also, robotic repair takes longer and thus, you are on the pump longer. Also, if your robotic repair is unsuccessful, they will have to divert to OHS.

Think of it this way. You have a messy closet that you'd like to organize today. What would be faster and more efficient? Drilling two large holes in the closet door, and using robotic arms and a mounted camera to go through your stuff, or simply opening the closet door and using your own hands?

I have been where you are, and I could have had Murphy perform my surgery. Even if he can claim a 98-99% repair rate (which is the highest I've ever heard), doesn't mean it is a durable repair. In the end, I'm sure you don't want to go through this again.

Again, I'm sorry, but I feel that you need to know this before making your final decision.

Take care.

 

[cmdm]

Dear Trudibeth77 and chaidell, I too have a severe MV condition waiting for a verdict tomorrow from my surgeon. Your bravery is an inspiration to me. Best wishes to you both; you will be in my thoughts. I will be waiting to see your posts after surgery.

With a grateful heart,
Dominique

 

[Trixie]

I had my repair via OHS--I think that is why I am so upset. Not only did I have a repair fail but my recovery was loaded with complications! I am that 1%-I am sure you will all be fine.

 

[chaidell]

That is terrible to hear . I'd be interested to learn what exactly caused the failure. How were your echo's immediately following your surgery?

 

[ejc61]

Good luck to you. It will be fine.