Update/ question

[cpj123]

Saw the surgeon and he officially put me off until November. Actually even hedged his bets on that ...my cardio really wanted to rush it after a nasty case of endo. but after CT I am at 4CM and otherwise healthy. To be honest I was ready also but I have really felt better..basically that is one nasty illness and it took a full 2 months to feel normal...catch 22 I guess...I did not know about my BAV until I got sick...I could have done without being sick but at the same time I might have found out in a more tragic way.

Now that I have a confirmed enlargement my surgeon said no to the less invasive procedure..but he hedged his bets a bit...my question is it totally out of the question or are some docs doing it?.....know that I have a window of time a 2nd opinion could work out pretty easily and Duke is right down the road.

 

[pellicle]

Hi

Now that I have a confirmed enlargement my surgeon said no to the less invasive procedure..but he hedged his bets a bit...my question is it totally out of the question or are some docs doing it?.....know that I have a window of time a 2nd opinion could work out pretty easily and Duke is right down the road.

for my own part I'm not sure what "the big deal" is with the so called minimal invasive OHS vs the way its been done for years. I suspect that it is mainly that the catchword minimally invasive is in vogue in the media. I understand that in some areas keyhole sugery (laparoscopy) has many advantages, but that is where the thing being operated on is small and simple and the idea is to minimise access damage for what is essentially a small operation. I don't think valve replacement is really quite in that category.

Still there have been some small gains in patient healing time but then again I understood it had increased complication rates. Time will tell

With respect to your hospital choice I thought that those medical review sites mentioned earlier were quite good and quite telling, I would be inclined to go to the better hospital if its "just down the road" ... Don't bullshit around with that, because I can assure you from personal experience you don't want to get an infection from the surgery. I am *still* on antibiotics and still seeing my infection control specialist every 6 months. My case is "in remission" but he is cautious to cease the antibiotics in case it is not actually gone (merely held in check). That could well be fatal and at minimum would require a LOT of undesirable surgery (probably removal of my sternum permanently).

This is not choosing a washing machine, this is serious and significant stuff and risk management is the name of the game.

I may be mistaken but you seem to be beginning to start kidding yourself when I read:

To be honest I was ready also but I have really felt better..basically that is one nasty illness and it took a full 2 months to feel normal...catch 22 I guess...I did not know about my BAV until I got sick.

I'm not sure ... so I'll say this: make no mistake, once this conditions is identified and is out in the open its a choice
* do the surgery and return to a healthy life
* die slowly from loss of health via the well documented pathways of aortic stenosis and increased risk of endocarditius.

before OHS everyone only had option 2

Its also important to get it done when it needs to be done. Delay brings risk of damage and other bouts of endo. Surgeons are risk management specialists. They (should) only advocate surgery when the risk of death is higher not having it.

Its true you could have gone through your whole life and never known. Its also true that you could have had 10 years longer and healthier high quality of life if it had been identified and treated. However for you it has been identified which means that you're not in that category anymore.

I was diagnosed at 5 or so, so its been a lifetime of this for me, so my views on things are no doubt shaped by that.

Best Wishes

 

[Paleowoman]

for my own part I'm not sure what "the big deal" is with the so called minimal invasive OHS vs the way its been done for years. I suspect that it is mainly that the catchword minimally invasive is in vogue in the media.

I have to agree ! It's hardly "minimally invasive", it is still major open heart surgery, it's just they gain access to the valve being replaced through a smaller incision than traditionally. Nothing else about the surgery is "minimal", the patient is put on the heart lung machine, the heart is stopped, etc, all just the same. I suspect that the between the ribs incision may be less painful post surgery than through the sternum though.

Real minimaly invasive AVR is, of course, the TAVR but they don't call it that even though it's hardly invasive at all !

 

[Boomanchu]

I had asked my surgeon about it and he told me that it's quite a bit more painful post surgery but the recovery time is much quicker. Never spoke to anyone that has had it.

 

[epstns]

When I spoke with my surgeon about minimally invasive procedures, his opinion was that the internal healing and heart recovery would be the same. The only difference would be in the time it takes the "collateral damage" to heal (muscle and bone tissue, etc.), and that this healing of the parts they cut to gain access to your heart are the lesser part of the over-all healing process. While you may feel a bit better a bit sooner, your heart will heal at the same rate, regardless of how the surgeon gets there.

Also, my surgeon felt that he personally would rather have full access to my heart to do his work. If he used a minimally invasive procedure, he might not be able to get the best access to the parts of the heart that he needs to fix.

As it ended up, my case was a moot point, as we opted to also do a pre-emptive bypass of a partially blocked artery. The combination of doing my valve and the access needed to do the bypass meant that I had to have the conventional sternotomy. The surgeon was, however, able to keep my scar down to about 4 inches in length. I healed fine, in around the normal time span.