"Minimally invasive" means...

[Leah]

Hello. I hope "heart talk" is the right place for this thread. (Not exactly about valve selection but "heart talk" is pretty broad... Still getting a feel for the site.)

From what I've read so far, "minimally invasive" valve replacement surgery still involves cutting the breastbone but the cut is substantially smaller, maybe 3 or 4 inches instead of 8. (At least this is what I get from Cleveland Clinic's website.) Sounds better than the alternative, if you're a candidate, and I may be, but...I have a friend who had "maximally invasive" OHS on an emergency basis a couple of years ago (multiple bypass PLUS valve replacement) and his recent comment was, "the only reason I'd consider going out of town for surgery would be to avoid having my breastbone cracked!"

I assume that any time you're doing something this major to a human body, "minimally invasive" is a bit of a euphemism, but what's the reality? Can anyone help me understand this better in real-world terms? I've seen references to minimally invasive surgery through the side, but haven't seen references to doing this for AVR.

Thanks in advance for any insight you can provide!

Leah

 

[Adrienne]

There are certain minimally invasive techniques which go through the right side between the ribs, under the right breast, leaving just a small scar. There are several people on this site who have had this type of surgery, and I am sure they will answer soon.

 

[Cooker]

I had AVR and the surgeon told me in my case it would mean a partial sternectomy and that the healing time would be about the same.....I am sure it depends on what you are having done as to what it means.

 

[marie]

I've had minimally invasive. I have a three inch cut over my right breast. They collasped my right lung and spread the ribs. I can not compare it pain wise to the breast bone cut. The pain and healing went well except I had shoulder pain for seven weeks straight every single day. I am 10 weeks out tomorrow and doing well. Also had a cut under the right breast for the drain tube and one in my left groin for the heart/lung machine.
Good luck Earline

 

[MikeHeim]

I have the 4-5" mini-sternectomy version of minimally invasive, and haven't had any issues. You will get many responses of people who have had other versions.

One thing to note is that minimally invasive does not necessarily mean minimal pain, minimal recovery time, or minimal complications. I get the impression that many people believe that coming in. In fact, the way I understand it, going through a person's side instead of the sternum is actually much more painful because the surgeon has to cut through muscles and soft tissue instead of bone. On the other hand, a person who does not have their sternum cut shouldn't have many of the post op restrictions in place (such as lifting and driving) that are primarily issued to protect the healing sternum. There are, of course, cosmetic advantages as well. As with everything in heart surgery, there is no perfect easy answer and you just need to balance the pros and cons of each approach and decide what works best for you.

 

[marie]

I have the 4-5" mini-sternectomy version of minimally invasive, and haven't had any issues. You will get many responses of people who have had other versions.

One thing to note is that minimally invasive does not necessarily mean minimal pain, minimal recovery time, or minimal complications. I get the impression that many people believe that coming in. In fact, the way I understand it, going through a person's side instead of the sternum is actually much more painful because the surgeon has to cut through muscles and soft tissue instead of bone. On the other hand, a person who does not have their sternum cut shouldn't have many of the post op restrictions in place (such as lifting and driving) that are primarily issued to protect the healing sternum. There are, of course, cosmetic advantages as well. As with everything in heart surgery, there is no perfect easy answer and you just need to balance the pros and cons of each approach and decide what works best for you.

I have the same restrictions. I am 10 weeks out can not lift anything over 15 lbs and started driving at 8 weeks. Like we always say everyone is different.
Earline

 

[ctyguy]

I had a minimally invasive Aortic Valve replacement at C.C. My incision was right in the middle of my chest, probably 4 to 5 inches long. They still have to cut the breastbone and I don't think the healing time is any different. Im just over 4 weeks post-op, my incision is about 1/2 way healed at this point. I can't do any lifting of significance without some discomfort. I can lift a gallon of milk and such but nothing much larger. I probably could actually, but why risk it ? I will give it the 3 months to properly heal. Just like anything, if it hurts, don't do that ! I think the term "minimally invasive" really centers around the scar, I think under the covers(or skin) everything else is the same.

 

[cp172]

I had minimal invasive surgery for repair of MV on Feb 7th. The incision is under the right nipple. No broken ribs.Surgeon released me after three weeks for driving and return to work. There are all kinds of holes for camera's, chest tubes, etc (about 10). More discomfort than pain. Good luck!

 

[DebbyA]

"Minimally invasive" seems to be an umbrella term that has multiple meanings.
Here is another link from the Cleveland Clinic:

http://www.clevelandclinic.org/heartcenter/pub/guide/disease/mini_invasivehs.htm

My own impression struggling with the terminology was that "minimally invasive" is offered more often for mitral valve than for aortic. If you talk to a surgeon about a minimally invasive approach, be sure to pin him down on how many he has done for the aortic valve, exactly where your incision will be, how that approach differs in how your lungs, ribs, nerves are handled, and how long you will be on the heart-lung machine as opposed to traditional sternotomy.
If you are concerned most about pain or activity after surgery, talk to a nurse or physician assistant at the surgeon's office, or to you cardiologist. I had a wonderful surgeon, but did not see him (nor was seen by him) after surgery day.

Best wishes!

 

[ruth]

My MV repair was called a "right thorocotomy" which in English means I have a scar under my right breast that is about 4-5 inches long and is exactly where an underwire on a bra would rest on the chest wall. My surgery was done between my ribs, no bones were cut, bruised, but not cut.

I have heard the partial sternum cut, where they cut about halfway down the breastbone & hang a right angle as "min invasive".

I've also heard of the robotic approach which involves a chest incision (I think through the ribs) with a really short cut and extra cuts for the robotic arms referred to as "min invasive".

Personally I think the term "minimally invasive" OHS is a contradiction in terms since there is not a single thing minimally invasive about OHS no matter what path they take to get in there. I think they should rename it "non full sternum cut".

For the surgery I had there were some caveats. One, in order to be able to get in there I had to be relatively tall (I'm 5'6") and relatively slender. If a CABG is required then they said they would have to do a full sternum cut.

I wish you all the best, welcome!

Peace,
Ruth

 

[Leah]

Thank you

Thank you

Thank you for all the replies. I guess it's like minimally invasive brain surgery!
Leah