Question for clarification on full-sternum vs. minimally invasive...

[sonavogel]

I think I need clarification on a point; I've been reading threads, but I'm not sure about it:

Is one of the (to me significant) differences between a full-sternum OHS and a minimally invasive procedure that the former does not need to deflate a lung (or push it out of the way), while the latter requires the lung (left?) to be deflated--thus potentially causing scarring or pleural effusion--in order to work within a smaller space?

I'd been growing quite fond of minimally invasive techniques until this cropped up. It's hard enough to get the lungs working properly after OHS, under any circumstances, with the potential for fluid buildup and other complications. I'd hate to think that this additional risk is par for the course with MI surgery.

Does anyone know if lung deflation (or clamping it down or the like) is a requirement always--and only--for MI surgery?

Thanks!

Best, Sona

 

[hensylee]

I can't answer your question, but can say that those of us who had full sternum were on heart/lung machine.

 

[catwoman]

Sona:

I had a sternotomy and was on the heart/lung machine. My husband had a MI and was also on the heart/lung machine. Neither of us had any pleural effusion.

It's just my guess, but I'd say that most OHS involve a sternotomy and heart/lung bypass machine. At least, all valve surgeries require the bypass machine and most CABGs do, except for the "beating heart" procedures.

 

[sonavogel]

I think I must be confused: Is there no difference, then, between having a lung "deflated" and being on the heart/lung bypass machine? Are these the same thing?

 

[bvdr]

I think I must be confused: Is there no difference, then, between having a lung "deflated" and being on the heart/lung bypass machine? Are these the same thing?

There is different endotracheal equipment used during a less evasive thoracic approach than a sternal approach. There is a double lumen tube used that effectively allows one of the lungs to be inflated while the other is deflated. I think you can find some information on it on the Heart Port web page. I think it all depends on what procedure is being used and what approach is taken.

The minimally invasive approaches are being improved all the time. The explanation for my lung scarring was that it was a result of having the type of surgery I had had. Both my PCP and Cardiologist told me this was the case. I never asked my surgeon who may be of a different opinion. People's bodies react to things differently and what happened to me may not be at all common (although it happened to the mom of one of my cardiologist's partners as well). I know my surgeon is one of the very best and am confident he did things correctly but as I said, everyone reacts a little differently. Try this link http://www.ciap.health.nsw.gov.au/hospolic/stvincents/stvin98/a11.html

 

[sonavogel]

Thank you, Betty--that's an interesting article, and I will do a Google search to try to find others. I obviously need to learn a bit more about how the lungs are handled in both types of operations.

Best, sona

 

[halleyg]

Hi Sona - my first OHS was minimally invasive and I believe both of my lungs were deflated. I didn't have any kind of problems with my lungs post-surgery except for the pain. A few days after I got home I could hardly breathe for the pain but after that, it was OK as far as my lungs were concerned. Oh, and I was also on the bypass machine. I am having the invasive surgery in a couple of weeks and from what I can tell you, the techniques are different, but you are on bypass for both.

 

[sonavogel]

Hi, Halley~

Just saw your post, and I wish you the best of luck on this, your second OHS! I must check on your other posts to get specifics on your situation. In the meantime:

I am having the invasive surgery in a couple of weeks and from what I can tell you, the techniques are different, but you are on bypass for both.

If you are on the bypass, will they be deflating both lungs again for this surgery, as they did for your minimally invasive procedure?

I'm very glad to read you had no aftereffects from the first time--with your lungs, I mean. I wish you a "noneventful" second time around!

Best, Sona

 

[halleyg]

Hi Sona, thanks so much for the well-wishes! This time around I am having the full-sternum; they aren't going through my ribs again b/c of scar tissue. I assume that they will be deflating both lungs, as I will be on the heart/lung machine again. If I find out anything different between now and then I will be sure to let you know.

 

[MaryC]

Hi Sona, thanks so much for the well-wishes! This time around I am having the full-sternum; they aren't going through my ribs again b/c of scar tissue. I assume that they will be deflating both lungs, as I will be on the heart/lung machine again. If I find out anything different between now and then I will be sure to let you know.

Halley,
Did the surgeon say why the scar tissue ruled out minimally invasive surgery? My surgeon has said there would be no issue with my having port access again in the future if I have to have surgery again. He told me I can plan on having another surgery in my lifetime.

 

[Adrienne]

He told me I can plan on having another surgery in my lifetime.

Do you mean that your surgeon thinks you will need another surgery in your lifetime or does he just mean that if you need one, there will be no problem? If he indeed thinks you will need another one day, why does he think that the repair will not last?

 

[MaryC]

Do you mean that your surgeon thinks you will need another surgery in your lifetime or does he just mean that if you need one, there will be no problem? If he indeed thinks you will need another one day, why does he think that the repair will not last?

Adrienne,
Dr Ryan said he tells his MV patients to plan on 2 surgeries in their lifetime. It makes sense to me, because at 45, I could live (God willing!) another 30 or 40 years. The odds are my valve will need to have something done again. He said there is the possibilty of the valve being re-repaired.

 

[Adrienne]

MaryC, you're scaring me! Although I am older than you (I'm 62 and had my surgery at 60), there is longevity in my family, and barring heart problems, I could easily live until at least 90. I really worry about one day needing another OHS. My surgeon seems confident, but maybe he just doesn't want to worry me since he can tell that I am a "hyper" type person!

 

[WayneGM]

MaryC, you're scaring me! Although I am older than you (I'm 62 and had my surgery at 60), there is longevity in my family, and barring heart problems, I could easily live until at least 90. I really worry about one day needing another OHS. My surgeon seems confident, but maybe he just doesn't want to worry me since he can tell that I am a "hyper" type person!

I'm only 52, and had my surgery at 51. My Surgeon was confident, barring any complications, that my repair would last my life time. Longevity runs on my Mom's side of the family and I tend to take after my Mom, although I doubt he took that into consideration. I'm hoping he's right as I wasn''t "planning" to have another OHS, at least one related to my mitral valve repair. Of course, even if I do need a re-op in the future, I'm hoping it is far enough away that the techniques and technology would have evolved sufficiently that the OHS experience is totally different (for the better) from today. It may be prudent to tell a patient to expect 2 surgeries in their lifetime, but that doesn't make it so. IMHO best not to think about it, and take it day by day.

 

[MaryC]

I'm only 52, and had my surgery at 51. My Surgeon was confident, barring any complications, that my repair would last my life time. Longevity runs on my Mom's side of the family and I tend to take after my Mom, although I doubt he took that into consideration. I'm hoping he's right as I wasn''t "planning" to have another OHS, at least one related to my mitral valve repair. Of course, even if I do need a re-op in the future, I'm hoping it is far enough away that the techniques and technology would have evolved sufficiently that the OHS experience is totally different (for the better) from today. It may be prudent to tell a patient to expect 2 surgeries in their lifetime, but that doesn't make it so. IMHO best not to think about it, and take it day by day.

Gee, Wayne......I thought I was being optimistic thinking I might outlive my valve repair! (FYI - Longevity doesn't run in my immediate family - Mom died at 53, dad at 65, brother at 47...various causes.)

 

[WayneGM]

Gee, Wayne......I thought I was being optimistic thinking I might outlive my valve repair! (FYI - Longevity doesn't run in my immediate family - Mom died at 53, dad at 65, brother at 47...various causes.)

Either I'm optimistic......or in denial. Don't know for sure! lol

 

[catwoman]

This is just Dr. Marsha speculating here, but I'm going to venture an uneducated guess:

A reop on a repair might be contingent upon the nature of the problem that required the first surgery.
That is, if John Doe had his mitral valve repaired because he had a ruptured chordae and there was no other problem, it stands to reason that he shouldn't need a reop.
However, Jane Smith had degenerative leaflet tissue. She had a repair, but she might possibly face a reop if the rest of the tissue degenerates.

Anyone else want to venture an uneducated guess here?

 

[MaryC]

Marsha,
I believe you hit the nail on the head. My life plan is to not worry about a re-op....got enough on my plate right now trying to recover from my first surgery! I do appreciate being given realistic information - and the discussion with Dr Ryan was around my having a diseased valve, as opposed to your husband's situation. I was in a fairy tale world before with my original cardio - not really seeing surgery in the picture.

 

[WayneGM]

You are probably right, "Dr. Marsha".

As far as I know, I do not have a diseased valve. Dr. David's explanation of my condition was that the valve leaflets and the chordae act as a parachute, and some of the guide ropes of the parachute broke causing the leak. The broken guide ropes (the chordae) were replaced with synthetic fibre. He also used a Simplici-T Band to help restore the leaking valve's opening to a more-normal shape so it would have an improved seal.

As a side note, I later learned that Dr. David himself worked with the engineers from Medtronic to design the Simplici-T Band system for use in mitral and tricuspid valve repairs.

 

[Adrienne]

I was in a fairy tale world before with my original cardio - not really seeing surgery in the picture.

Me too!!! That is until I had endocarditis in 2004 and the doctors at the hospital talked about surgery. It is then that I started on my quest for second, third and fourth opinions. By the way, I don't have the same cardio anymore!

On the surgery report which I ordered and received about a month ago, it says I have Barlow's Disease, the type of mitral valve prolapse that is thick and degenerative. The surgeon also mentioned once that the endocarditis probably caused a lot of the calcification.

In any case, it was a very complicated repair. I also had synthetic cordae (Gortex) put in to replace two ruptured cordae. So, despite my surgeon's fantastic handiwork, I still worry about a re-op sometime in my future.