Mital valve replacement, Min Invasive Vs Sternotomy

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E

Espoe

I am sure much has been written about this and I have seen some things posted here on this subject so forgive me if I am revisiting this. I had a mitral valve repair done 9 1/2 years ago which is now leaking badly. My TEE shows, and my doctors agree, that a mitral valve replacement is needed and that repair is not really an option.

I am 49 years old and am electing the mechanical valve as the way to go for me based on my doctors advice and a little research including this forum. I am also in chronic A-Fib and have been for at least 20 years. I am used to ACT and don't think too much about that really since i have been doing it for so long.

I would like to have the abilation for the A-Fib and the valve repalcement done at the same time. I know this is possible with the sternotomy but not sure about the minimally invasive methods. Also there is no minimally invasive method in my area of New Orleans so i would have to travel to have the procedures done if I choose to go that way.

So my questions are is the minimally invasive procedure much easier on you, what is the difference in the recovery times, considering travel (and BTW there are no direct flights from N.O. to most places) is the less invasive procedure that beneficial etc..

I am just looking for some real life experiences with replacement. A lot of what I have seen posted has to do with the hope of repair. I know already that replacement is where we are going so some insight here will be greatly appreciated. I have already had a sternotomy so I am not afraid of that procedure but I wouldn't necessarily stand in line to have one!

I am shooting for a July procedure. Thanks in Advance for your input, this is a very helpful and supportive forum.
 
Welcome to the zoo:D ? Can?t help with what I think is your main question ?if replacement and ablation can be done with minimally invasive technique?? ? but I had my ablation done with my AVR and have not had any trouble with a-fib since ? Wishing you well!!
 
Just wanted to welcome you.

I had my aortic valve replaced by Dr Victor Tedesco IV at the Heart Hospital in Lafayette, La. by minimally invasive. Dr Tedesco onced practiced in New Orleans (I think Turo) prior to hurricane Katrina.

I did not have A-Fib prior to surgery so I can not comment on if that can be corrected my minimally invasive.

Never had sternotomy so it's not possible for me to compare the two. I can tell you I didn't have much pain for the cut but I had SEVERE left shoulder pain for weeks after.

Good luck and keep us posted.
Earline
 
I had the full sternototomy and my pain wasn't really that bad. I barely used any of the pain medicine once I was discharged from the hospital. There are plenty of surgeons at the Texas Heart Institute, as well as other hospitals, in Houston who have done minimally invasive surgery, although I'm not sure about ablation. I believe there are several direct flights each day from Houston to New Orleans, although I haven't checked since Katrina.
 
As I understand, there are several levels of less invasive techniques. For mitral valves, some surgeons go through the ribs and do a replacement. So no robotic surgery with heart ports, but still less invasive.
 
I had the full sternotomy for my replacement and if I needed more I would be happy to go that way again. Call me old fashioned but I want the surgeon to have as much space as he needs to work comfortably, I don't want him inconvenienced in any way so that I have a smaller incision.
 
Hello and welcome. I have had both a sternotomy and minimally invasive with the heart port. For me the sternotomy was so much better, but I think that may have just been my particular case.. I know many people have had that kind of OHS with much less pain. Just ask lots of questions is the advice I always give! Best of luck.
 
For the Mitral Valve, I am keenly interested in the On-X Mechanical Valve because it has been designed to reduce several of the risks for clot formation.

There is a surgeon at Vanderbilt in Nashville, TN, Dr. Petracek, who specializes in minimally invasive Thoracotomy (through the ribs), especially for the Mitral Valve. He reports that he does 200 of these per year. I have the impression that he only uses St. Jude Valves. You can see a video of one of his procedures through a link on his website (do a Google Search to find it).

Surely there are Surgeons in Texas who use On-X and do minimally invasive surgeries....
 
My surgeon said that for work on the mitral valve he preferred minimal invasive surgery because it offered a superior angle. I was driving and back at work three weeks after surgery (surgeon used DaVinci robot). I was scheduled for an ablation because of AF so I guess they can do them when doing MIS (frankly am unsure if they did one on me).I hope this helps.
 
Hi Espoe

I had a minimally invasive mitral repair done 16 days ago and I?d imagine that generally the recovery time (all other things being equal) is significantly quicker. Like CP, I?m driving (short distances, albeit illegally) and could consider starting work again now if I chose. I can?t help either with the ablation issue, but I travelled home about 600 km (400 miles?) by car/plane/taxi on day 13, carrying a 20 pound bag short distances on my ?good? (left) side. In hindsight that was a bit silly (I should have used a wheeled bag), but the travel probably would have been much harder had I had traditional OHS.

I?m quite active now (gym, walking, visits to the pub, pottering around town etc), but I get tired in the afternoons. I?ve also had a reasonable amount of incision pain ever since the operation, but nothing unbearable, and they warned me it would hurt! At present it?s a fairly constant 2-3/10, slightly worse in the mornings. I?ve noticed the swelling of the right breast (which was very pronounced after the operation) is starting to subside, although it?s still quite numb and doesn?t look normal yet.

Hope this helps,
Andy
 
How about this guy from Peachtree Cardiovascular in Atlanta?

He is Very Highly Regarded and has received complimentary reports from VR.com members who have used his services. AND, he has implanted several On-X Valves.

From http://www.peachtreecardiovascular.com/oursurgeons/

Dr. J. Alan Wolfe has been practicing cardiothoracic surgery since the completion of his postgraduate training in 1992. Postgraduate training consisted of internship at Brigham and Womens Hospital from 1984 to 1985 and residency at Brigham and Womens Hospital from 1985 to 1990, Bellevue Hospital and New York University Hospital from 1990 to 1992.

Areas of interest: minimally invasive mitral valve surgery using port access and aortic valve surgery utilizing small incisions.

This guy looks VERY GOOD to me.

'AL Capshaw'
 
ALCapshaw2 said:
How about this guy from Peachtree Cardiovascular in Atlanta?

He is Very Highly Regarded and has received complimentary reports from VR.com members who have used his services. AND, he has implanted several On-X Valves.
Click to expand...

Al, you are right, this man is a wondeful surgeon. This is the practice I used, different surgeon. Dr. Murphy just performed a robotic on a family friend last week to repair his MV. My mom said he is doing great! God forbid I ever had to do this again, he would be at the top of my list. I feel as I shouldn't post about my minimally invasive sometimes, as it was a total fluke. I have only heard positive stories otherwise.
 
Thanks to everyone for their replies. As I said July will be my date with the knife. I have some time for valve research. What I am really trying to get a hold on is which type of procedure I am going to choose. Unless I am missing something I am not seeing an overwhelming reduction in recovery time, pain or superiority of one procedure over another.

According to the posts I have read, the min Inv. method has a small recovery advantage, but still is a difficult recovery due to cutting the muscle. Other Min Invasive methods only reduce the size of the sternum cuts. The sternotomy method means I could have it done at home by a doctor that does these nearly everyday and has been doing that for years.

Right now I don't see anything compelling yet about travelling for the min. Invasive method. If I am incorrect about any of this, or have a misimpression, I want to get clear before I say one method or the other.

I hope that clarifies a little and again thanks to everyone for their posts!
 
Welcome and all the best with your surgery. Sorry can't help with the question.
 
I had MVR via the heart port method through my right chest. I know I was driving earlier than those who had surgeries through their sternums. I had significant pain but mostly with muscle spasms in my ribs. I had it done 5 years ago when I was 55. I've got a St. Jude and it has worked just fine.
 
Thanks for all of the suggestions. I got a call from the cleveland clinic yestersday and it looks like the smaller sternotomy would be the way they would go because of my past surgery and scar tissue. NOt sure if this is really advantageous enough to go to Cleveland. I may post seperately on this issue.

This is a great forum and I have gotten some really good information.
 
I sought out a surgeon who performed minimally invasive surgery (port access) and was pleased with my results. I think it's a combination of the surgeon and anestesiologist because I have heard some people say they had a lot of pain with minimally invasive surgery. I didn't really have any pain...just discomfort. My anestesiologist used a pain pump on the side where the incision was made (between my ribs) and maybe that was the difference. If I have to have another surgery I will want the same procedure.

Chris
 
This if my 1st post on this site, as I've been waiting for the right opportunity. I'm a physician (not a heart surgeon) and will have AVS soon. So I'm at lunch with a cardiovascular surgeon and an anesthesiologist, and hear the following conversation:

Anesth: "Why do you do minimally invasive surgery?"
CVS: "Some patients want it."
Anesth: "Is it easier for you?"
CVS: "Nope, harder. Can't see as much, exposure isn't as good."
Anesth: "Is it easier for the patient?"
CVS: "Nope, hurts more."
Anesth: "Then, why do you do minimally invasive surgery?"
CVS: "Some patients want it."

Neither of them (at that time) knew I had surgery coming up.
 
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