Thoughts on minimally invasive aortic valve replacement?

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Wulfie

Member
Joined
May 24, 2011
Messages
8
Location
Shreveport LA
Hey everyone,
new to this forum and glad to find you! I'm male, almost 56, lifelong retail manager and professional musician (bass player!). Have aortic stenosis congenitally and my cardiologist says it's time to start discussing surgery. After a little research, of course I'm interested in minimally invasive procedures; no cutting of the sternum, less downtime and quicker rehab. In good shape at 5'10" and 165lbs. Any experience and/or opinions on this? Thanks for your response :cool: Wulfie
 
Greetings to a fellow bassist! I played electric bass (and trombone) semi-professionally for years.

I just asked my cardiologist at the University of Pennsylvania about minimally invasive OHS. HE said that just about all the surgeons there are using minimally invasive techniques even for more complex surgeries (valve/aneurysm repair.) The technique I've read the most about does involve some cutting of the sternum ("mini-sternotomy or "J" incision, although I have heard of surgical incisions in between the ribs that do not involve the sternum.) Of course it all depends upon your particular circumstances whether or not you are a candidate. Only your surgeon of choice can tell you.

Jim
 
Last edited:
Hey Jim,
Nice to meet you and thanks for the reply! The music store I manage is the only woodwind/ brasswind store in this whole region,
so I'm very familiar with t bones. And hey it's all bass clef anyway, right? Of course I'd like to avoid any sternum cutting if I can. This
Edwards valve they're working with in Europe sounds great...they insert it through a catheter!! Only problem right now is they don't know
how long it will last . Thanks again buddy Wulfie
 
Thanks
very much for the welcome, buddy, I appreciate it. Hope to get armed with a lot of info and meet some
new friends like you here! Wulfie
 
Wulfie said:
Hey Jim,
Nice to meet you and thanks for the reply! The music store I manage is the only woodwind/ brasswind store in this whole region,
so I'm very familiar with t bones. And hey it's all bass clef anyway, right? Of course I'd like to avoid any sternum cutting if I can. This
Edwards valve they're working with in Europe sounds great...they insert it through a catheter!! Only problem right now is they don't know
how long it will last . Thanks again buddy Wulfie
Click to expand...

Hi Wulfie, I'm glad you found us, it's so good to find other people and not feel all alone.
IF you want a min invasive surgery and your first surgeon says no, you could always get another opinion, altho as others said, depending on what you need doe you might not be a candidate.

Also about the Edwards Sapien Aortic valve, http://www.clinicaltrials.gov/ct2/show/study/NCT00530894?term=sapien&rank=1&show_locs=Y#locn they already had been doing trials for it in the US for a couple years,
first JUST for people who were too high risk so not a candidate for surgery and now just for "higher risk" patients (I think for people given a 10% mortality rate).
There are quite a few threads on them here if you search for Sapien or "percutaneous" Here is one about the last update on the trials http://www.valvereplacement.org/for...alves-noninferior-to-surgery&highlight=sapien
Also they JUST stared trials in the US for Medtronics coreValve http://www.clinicaltrials.gov/ct2/show/study/NCT01240902?term=corevalve&rank=4&show_locs=Y#locn both of the link to the gov clinical trial site have the hospitals taking part in the trial at the bottom

Hopefully you are much too healthy to qualify to have a percutaneous valve now, but many people believe IF you get a tissue valve now by the time this valve needs replaced it could be done by cath. I wouldn' count on that when making your decision tho since who knows what can happen,
 
I had my aortic valve replaced through a small thoracotomy incision. The incision was between 2 ribs on the right side of my chest; it's about 3 inches and is about 3 or 4 inches down from my collarbone. For mitral valve replacement, I understand the incision is a bit lower down the chest. I was glad to have this approach, and asked for it as I preferred not to have my sternum broken. I didn't have much pain after surgery, and was able to drive in 2 weeks. It also did not hurt to cough after surgery, something I hear is painful after a broken sternum.
 
Hi, I just had minimally invasive surgery-aortic valve replacement. The valve is AWESOME, from .8cm to2.3cm!
Unfortunately like many others here, I did NOT get the licence plate of the truck. It must have bee a coal truck, and I ---inhaled. It's going on 10weeks now, and the hacking cough is still with me, and also a low grade fever. Sincerely glad my sternum was left alone!!!
The caveat...I would advise against getting a major top surgeon, if the hospital in which he has priveleges is not equally highly rated, the best ratings (most thorough) ive found are US News and World Report. Yours thru a fit of coughing!!! Michellemar
 
I was initially attracted (why not?) to something less invasive, but the world-class surgeon my cardiologist referred me to, likes to stick to the tried and true. I'm usually pushier than average, but I let him do it the way that made him comfortable. My discomfort didn't last long, though I'm glad I didn't have any sneezing fits in the first few days post-op. Coughing wasn't fun, but it wasn't terrible, with the pillow clutched to the chest. And the long "zipper" incision is fading pretty nicely. I had virtually no pain through the whole thing, though that part of the experience varies hugely from person to person.
 
A lot depends upon the surgeon you choose. My experience was initially similar to Norm's in that the surgeon preferred the full sternotomy. He said that he preferred it because then there was no likelihood that they might have to convert from a partial to full sternotomy if they ran into unexpected issues once they had you open on the table. It became a moot point when it we learned that I would also need a bypass. The surgeon said that when they needed to perform other tasks while operating, that there is no option - they do a full sternotomy. They did offer a fair compromise in that they did cut my sternum from top to bottom, but the visible incision is only about the bottom half of the sternum's length. They can stretch the skin to allow full access while affording the patient a scar that is not visible when they are wearing normal clothing. This is, of course, usually of much more importance to the ladies, but I greatly appreciate the over-all neatness of their work.

As far as recovery goes, the duration of recovery is the same for a partial or full sternotomy. They told me that there wouldn't even be much difference in ease of movement or freedom from pain during recovery, because they said that the sternum is quite well supported by the wires used to close it. I can truthfully say that I was amazed at the lack of significant pain and restricted movement after surgery. I was able to use my arms quite well before even leaving the hospital, as long as I followed the docs' instructions as to weight limitations and where I could and could not reach toward.

Oh, BTW, most of the surgeons who do perform minimally invasive heart surgery will make you sign a consent decree that gives them permission to do the full sternotomy (or whatever else they need to do) in case of emergencies.
 
Hey Lyn
Thank you so much for the warm welcome, and yes it is nice to know you're not alone...what did we do before the internet, right?! Speaking
of that, the links are great and very informative. Hope everything is good with your son now!
Wulfie
 
Luana,
Thanks so much and that kind of feedback is so helpful! Exciting to hear that your recovery was so short....that's exactly
what I'm hoping for. Nice to meet you
Wulfie
 
Lots of good info
Steve, and I appreciate it. The consent decree makes a lot of sense once you really think about what they might be up
against when they get you on the table. Thanks man!
Wulfie
 
I had the Robotic/Min invasive done for mitral valve repair at Mayo Dec 27. I got up and walked out of ICU. Left hosp after 3 days and I felt good enough to go out for dinner NY Eve.

I can't say enough good things. But it is still major surgrey and even now (5 mos) I am not at the same level of fitness / endurance pre-op. But 90% aint too bad either.

Surgeon seemed really confident with my case and they had been doing a lot of these procedures. I learned that it is important that the hosp be doing volumes of these things.

They had another Dr with me in there in case they determined they wanted to convert to a reg open chest. They told me they would stick with Mr DaVinci if they felt they were getting the results, but would switch if there were any issues. They didnt have to.

I have a 3 inch scar under my right arm, with a few poke holes they needed for cameras.

I think I felt worse when I had my wisdom teeth out.
 
Wulfie said:
Luana,
Thanks so much and that kind of feedback is so helpful! Exciting to hear that your recovery was so short....that's exactly
what I'm hoping for. Nice to meet you
Wulfie
Click to expand...

Actually, I doubt that my recovery was any shorter than anyone else's. This is a big surgery, no matter where the incision is. One can drive sooner with no sternotomy, but at 2 weeks after surgery, I sure didn't feel like going to too many places.
 
I inquired about min-invasive surgery when I had my pre surgery visit with my sugeon. He commented that he did min-invasive, but he also prefered the full chest cut. He had several reasons that made a lot of sense to me. He said that there was a higher risk of complicatons and you were on the pump a little longer which is not always good.The most important comment I liked was that with the full opening he had more room to move his hands around thus making the surgery easier. I liken it to trying to thread a nut on a bolt in a tight area. The more room to move your fingers, the better. He also said that he likes to massage the heart to get the air out of it while putting it back togther. He said that trapped air in the vessels can go the brain and cause a stroke.
The surgeon is 55 yrs old and told me he himself had OHS at age 50. He seemed like a very good person to explain just what you go through.

I am 61 and very healthy otherwise and had no problems with the recovery. There was very little pain for me. Your sternum is put back togther so well so there is no movement to cause much discomfort. Granted, you don't want to do a lot or sneezing or coughing but it is not that painful. The back and the neck get more abuse than the rest of you.
Good luck either way you decide, but I really would'nt be afraid of the full proceedure.
 
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