Type of Surgery

[loretta]

I was wondering how many of you when getting a valve replaced had the tradtional type surgery (cut down the middle of chest) or the less invassive ( I had, cut under the breast) . Did you or your drs. prefer one to the other & why? Just curious. Loretta

 

[afraidofsurgery]

Opinion from my cardio

Opinion from my cardio

I was wondering how many of you when getting a valve replaced had the tradtional type surgery (cut down the middle of chest) or the less invassive ( I had, cut under the breast) . Did you or your drs. prefer one to the other & why? Just curious. Loretta

I haven't had my valve replacement surgery yet but have been discussing plans w/ my cardiologist. He said the down the middle approach was best for my aortic valve, it was too hard to get to from the less invasive. He also said if it were him, he'd go with the down the middle, since this is the easiest for the surgeon - he wouldn't want to add any risks or distractions for this surgery. I can see his point.

 

[Yaps]

I had down the chest, but I also had a quqdruple by-pass as well. So it may be different for others..

 

[geebee]

When I had my first surgery (in 1980) I do not believe many (if any) were doing the smaller incisions. I was cut down the middle (11.5 inches ). Since the scar was already there, no change in the type of entry was done in the 2 subsequent surgeries.

However, my last surgeon told me if I ever needed surgery again, there would be a need to try another path since I have so much scar tissue. Using the old entry would be too dangerous.

Hopefully I will never have to find out.

 

[Nancy]

Joe's first two were through the sternum. His third was HeartPort method through the ribs. This was to avoid scar tissue from previous surgeries.

 

[KathyH]

I had aortic valve replaced and aneurysm repair. My incision is in the middle, but only 4 inches long. It's amazing what they can do.
Kathy H

 

[bvdr]

The less invasive surgery is the most technically challenging and a surgeon has to do it regularily to feel comfortable doing it. The heartport way also requires a little more time on the pump.

 

[Kathleen]

One through five

One through five

First surgery full sternal incision
Second surgery full sternal incision
Third surgery full sternal incision
Fourth srugery, under the left arm then up to the mid back
Fifth surgery, under the left breast about 7 inches long
Can't imagine where they will go next.
Kathy

 

[MarkU]

Before my AVR my surgeon discussed the option of minimally invasive surgery through the side. His recommendation was to go the conventional route through the sternum. His reasoning was that they would have to be prepared to go in through the chest in case of any problems or complications, so they might as well go that way from the start. As it turned out the calcification of my valve and aortic root were a lot worse than they thought and they probably would have ended up opening my sternum anyway.

Mark

 

[CCRN]

Discomfort level

Discomfort level

Joe's first two were through the sternum. His third was HeartPort method through the ribs. This was to avoid scar tissue from previous surgeries.

We do minimally invasive approaches for both the mitral and aortic valves. Depends on which surgeon's doing the job. My surgeon initially told me I could have if either way but another one of his partners would have to do it. That partner turned pale when he heard it. I stuck with my original surgeon and the choice turned out to be a non-issue as I had to have a Bentall and you can't do that without a sternal approach. I was just wondering.....Did Joe notice any significant increase in pain with the heartport compared to the sternotomies? My surgeon's nurses told me the heartport patients had considerately more pain than the regular sternotomies. That, in addition to the possibility of opening the sternum AFTER making a chest wall incision kind of helped me feel good about having the traditional method.

 

[bvdr]

We do minimally invasive approaches for both the mitral and aortic valves. Depends on which surgeon's doing the job. My surgeon initially told me I could have if either way but another one of his partners would have to do it. That partner turned pale when he heard it. I stuck with my original surgeon and the choice turned out to be a non-issue as I had to have a Bentall and you can't do that without a sternal approach. I was just wondering.....Did Joe notice any significant increase in pain with the heartport compared to the sternotomies? My surgeon's nurses told me the heartport patients had considerately more pain than the regular sternotomies. That, in addition to the possibility of opening the sternum AFTER making a chest wall incision kind of helped me feel good about having the traditional method.

I can't speak for Joe , but for me, my pain issues were because of a pleural effusion and awful muscle spasms in my right rib cage. They were the kind that brought tears to my eyes. Since I never had my sternum split I have nothing to really compare it to. I do have quite a bit of scarring on my right lung that is presumed to have been from the procedure itself. I'm not sure if I would have it done that way again or not.

 

[liza]

Although I haven't had my valve replaced, I have had two heart surgeries in the past couple months. The first one was the full sternotomy for a valve repair, and the 2nd one was through my side for a pericardial window. The biggest difference? PAIN!!! If I had known the 2nd one was going to be so painful I would've gone through the sternum again. The only advantage to the thorocotomy was that I was able to drive 2 weeks before I could when they went through my sternum. But it's been 3 weeks since my 2nd surgery and I'm still dealing with alot of pain. I was off the percaset with my first surgery after less than a week. So honestly, if I ever had to heart surgery again, my vote is for the sternum. I may have been wimpy longer with that route, but at least it didn't hurt nearly as bad!

Liza

 

[OldManEmu]

My Surgery was the old fashion sternum job.
5cm below the top of the sternum to 2cm below the bottom of the sternum.
Before the surgery I couldn't believe this wasn't going to be unbelievably painful so I asked one of the doctors (who of course hadn't had heart surgery) he said most patients said it was sore rather than the agony that I imagined. I didn't believe him.
However after having been through it I would describe it as sore rather than painful.
When I woke from surgery I was wondering when the extreme pain was going to start and it didn't.

 

[Nancy]

The pain with HeartPort was definitely there. Joe's had two lung surgeries, and he told me that hands down, the lung surgeries were much more painful than heart surgery. So I would say that going through the side lung area is quite painful. There are also several small surgical incisions, one in the groin that he thought was painful for a while.

His early recovery was shortened by about one day, and of course, he didn't have bone pain to deal with.

Even though this was his third valve surgery, he did do well with it, that is, until he developed a severe serum sickness reaction to Ancef.

He had had Ancef before with no problems, but I guess, over time, he developed sensitivity to it. There was no warning to predict that this would happen. He went from being OK when he went to bed, to being wheelchair bound just after lunch the next day. He was in the ICU for about 2 weeks, in terrible condition, loss of kidney function, stiffened joints all over, and terrible pain. I was told not to go home the first night he was in the ICU with serum sickness. But I digress--

The surgery, itself, went much better than either of us had anticipated. He was out and about, going to the market, with me driving, a couple of days after getting home. Then serum sickness hit. Something else to think about with multiple surgeries.

 

[DuchessBear]

I wanted the minimally invasive approach because of the prospect of an easier recovery. My surgeon had a lot of experience with minimally invasive valve replacement, so we were both comfortable with my decision.

My surgeon used the HeartPort method to replace my mitral valve. I have a 3 inch horizontal scar just under my right breast. The surgeon went between the ribs -- no cutting of any bone. A small incision in my left groin is where they hooked up the heart-lung machine. I did not experience much pain or discomfort -- mostly it was muscle-type pain in the area of the chest incision, but 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.

 

[CCRN]

Pain

Pain

I wanted the minimally invasive approach because of the prospect of an easier recovery. My surgeon had a lot of experience with minimally invasive valve replacement, so we were both comfortable with my decision.

My surgeon used the HeartPort method to replace my mitral valve. I have a 3 inch horizontal scar just under my right breast. The surgeon went between the ribs -- no cutting of any bone. A small incision in my left groin is where they hooked up the heart-lung machine. I did not experience much pain or discomfort -- mostly it was muscle-type pain in the area of the chest incision, but 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.

Thanks everybody for your replies. I always like to confirm my information and there's nothing like getting straight from the source. You guys are great.

 

[samiam]

We used Dr Boyd, Cleveland Clinic, Weston FL, who is in charge of the Cardiothorasic and Minimally Invasive and Robotics. Since I am a wimp, I wanted to be cut as little as possible. He decided not to go with Robotics since, if there was a problem, I would have to be rolled over and cut again. He did a minimally invasive cut, about 4.5 inches of skin on the lower part of my sternum. For about 2 weeks, I had sharp pains when I put my arms in the wrong place. Other than that, nothing major.

 

[Phyllis]

Dick had minimally invasive through the sternum- about 4" long. Never had any problem with the incision. We researched to find Brigham and Dr. Cohn where he does most of his that way. If you also need bypass, it's a no go.

 

[loretta]

Less Invasive

Less Invasive

Seems like you & I had kind of the same surgery. Cut under the rt. breast & I really must say I had very little pain. I also took Percocet a few times in the hospital. My recovery was fast & painless. I did have pain when they pulled out of my chest a tube of some kind. Howevr, that was just for the few seconds it took to pull it out. I would highly recommend this surgery. Had it down at NYU MED> CENT>

I wanted the minimally invasive approach because of the prospect of an easier recovery. My surgeon had a lot of experience with minimally invasive valve replacement, so we were both comfortable with my decision.

My surgeon used the HeartPort method to replace my mitral valve. I have a 3 inch horizontal scar just under my right breast. The surgeon went between the ribs -- no cutting of any bone. A small incision in my left groin is where they hooked up the heart-lung machine. I did not experience much pain or discomfort -- mostly it was muscle-type pain in the area of the chest incision, but 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.

 

[labguides]

Our daughter (age 26) had a right mini thorocotomy. Pain definitely was a problem during her recovery. She had pleural effusion and once that was cleared up, her recovery was smoother.