AVR: Traditional vs. Minimally Invasive Surgery

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clawie1

Well-known member
Joined
Jun 9, 2013
Messages
72
Location
Torrance, Ca
Hi Everyone,
I am new to this forum so forgive me if this topic has been covered previously. I am a 73 year old female, very active, zumba 3x a week, strength train, and dance salsa. I had excellent results from my exercise treadmill test according to my doctor because my body is in good physical condition. The problem? I was diagnosed with mild aortic stenosis 13 years ago and the valve is gradually getting narrower. I know surgery will have to be done but according to the cardiologist I have to wait for symptoms to appear like fainting before I am considered a candidate. I live on pins and needles waiting for these symptoms to appear and do not understand this rationale. Question - Can anyone explain this to me? Also, I understand minimally invasive surgery may be an option - but who qualifies for this?

Thanks for all your help
 
Welcome to VR.org! I was told the time for surgery was BEFORE symptoms and before the heart becomes damaged ... I would get a second opinion. Now if you are high risk with other medical issues that may be different but I would still get another look. Good luck!!
 
Hi Cooker,
Thank you for replying. Now, have you had the surgery? Or are you still in the waiting stage? Can I read some of your past threads if you have them so you don't have to rewrite.
 
I'd get a new cardiologist. Any cardiologist that tells you to wait until you see symptoms/start fainting is probably not worth the paper their so called degree is written on. I agree with the earlier post. If you spend some time going through various threads you'll find a ton of info here, especially if you follow this board regularly. The timing of surgery can vary depending on what issues you have that need to be addressed. Change your settings in VR.org so that you can see threads earlier than the past 30 days and you'll get alot more info.

Re: minimally invasive surgery (i.e. TAVI/TAVR), this may be a bit of a generalization, but they currently typically perform this on patients who are high risk for open heart surgery. This may change over time as this type of surgery becomes more commonplace. Since you are 73 yrs old, you are much more likely a candidate than someone in their 40's though. Your candidacy also depends on what you are having done. There are other slightly less invasive procedures than a full sternotomy (smaller scar/smaller incision), but it depends on the extent of surgery required.
 
Hi Clawie,
Happy you found us but sorry for the reason.
I agree with the others that I would seek another opinion. Your cardiologist may be correct in his assessment you should wait for surgery but I'd want to have it confirmed.

I've had two OHS and my doctors all told me my recoveries were easier on me because of being physically fit. You are doing well to keep yourself in good shape. :)

Do lots of reading here. There are many years of threads and so much good information. If you don't find the info you are seeking, please ask. There is almost always someone who can help.
 
Hi T in YVR - Thanks for the reply but can you tell me how to change my settings to show older posts. I know I will get the hang of this sooner or later.
 
Clawie1

try searching on topics. Try also going to the forums in particular rather than just activitiy.

try also google with site:www.valvereplacement.org in the search followed by (after a space) the key words you wish to seek for

that will restrict your search to this site :)

regarding your question
I know surgery will have to be done but according to the cardiologist I have to wait for symptoms to appear like fainting before I am considered a candidate. I live on pins and needles waiting for these symptoms to appear and do not understand this rationale. Question - Can anyone explain this to me?
Click to expand...

I was initially balking at this one, but:

I can only suspect that the doctor is concerned at weighing risks VS benefits. Heart surgery is risky, as is your condition. Since on the face of it you seem to be doing well, then I suspect that the doctor is trying to see if you can continue to live as you are without exposing you to such risks like VERY major surgery. The risks of death in surgery for for the "minimally invasive surgery" of valve replacement look unfavourable to me...
 
clawie1 said:
Hi Cooker,
Thank you for replying. Now, have you had the surgery? Or are you still in the waiting stage? Can I read some of your past threads if you have them so you don't have to rewrite.
Click to expand...

I had my AVR 2-21-2006. I had no symptoms and all has been well. I really believe I did the right thing by going in before my heart was damaged. don’t worry about “hurting” feelings by getting second or third opinions. It’s your heart and your health.
 
I had minimally invasive surgery last August.

The surgeon said that as long as he didn't have to do any bypass surgery or any such thing, he could do minimally invasive surgery. He explained that he would cut a small cut off to the side of the sternum between the ribs. He would do the surgery through that opening. The healing would have none of the sternum healing concerns.

Things went well with this operation. He said that he had been doing it since 2007.

I can not understand why this isn't done more often. I figure it might take a highly motivated surgeon to become skilled in operating this way.

If I was a first time candidate for open heart surgery, I would check into this method.

Mike
 
Hi clawie1
I had my AVR two years this August. I had been a champion distance runner for my age for many years, when started to get
very fatigued in my races. I was told my Aortic valve was leaking! Here in Australia, we have a Public Waiting System, where I had to wait another 6 months! I lost most of my fitness, and by the 6 months, I had to stop 3-4 times on the small hill home.
If you can, get it done whilst you are fit, as recovery is much easier and quicker.
As has been said, I don't think you will get the 'less-invasive' operation, unless you have other problems.
See Ya
Brian

PS: I ran a 2km x-country race last Saturday, and a 5km race on sunday (15th and 16th June)!
 
Hi

I am assuming that this point:
clawie1 said:
I am a 73 year old female
Click to expand...

factored higher in the Dr's risk analysis than the other points.

Second opinion always a good option. I agree that if surgery is needed, then younger is better than older.

I don't think any of us here actually knows enough to make a decision as to why you may or may not be a candidate for minimally invasive surgery.
 
Hi T In YVR

I changed my settings and wow there is so much information. Thank you so much. I also see there are friends here to have had minimal invasive surgeries. It looks like I have a lot of catching up to do. Clawie
 
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Hi pellicle
I am doing lots of research on this site and following everyone's suggestions. I think I am getting the message that if minimally invasive surgery is an option for me I had better get a surgeon who does lots of them. Thanks again
 
Hi Haggis Basher,
As a started reading your story, I was saddened by the fact that this condition took so much from you and this is what I fear the most. As I read on, you said you had to wait another 6 mos. - that must have been an eternity for you given your lifestyle. The most encouraging news is the fact you are back to marathon racing and that is GREAT news. Thank you for inspiring me. Clawie
 
Here is a description of the minimally invasive surgery that was done on me. I ended up with a 6 inch incision in my upper right chest. I was told by the Dr. that as long as there were no other things needed he would do this type of incision. If bypass surgery was also needed, he would do the splitting of the sternum. There is a Mini-sternotomy that is done in some cases where only a short length of the sternum is split.

This all depends on the individuals situation and on the skill of the Doctor. I am very glad that my surgeon cared enough to do the minimally invasive incision and open me up between the ribs instead of splitting the sternum. Like he said, the heart operation was the same either way but I would like him a lot more if he went in between the ribs to do it.

I think too that if surgery is needed, go into it in the best condition that you can. Shouldn't wait until you are in bad shape cause recovery will be harder and longer.

Minimally Invasive Aortic Valve Surgery Incision Options
Incision A
Incision A is a minimally invasive option. It is 6-10 cm in length and the surgeon works between the ribs to get to the ascending aorta as it arises from the heart and hence the aortic valve. Advantages include a more cosmetic result, a less invasive approach with less tissue damage, less blood loss and potentially shorter time on the ventilator and shorter hospital stay, resulting in a faster recovery. It is a good option for elderly patients who are at or below their ideal body weight. It is not a good option for very muscular or heavy-set patients.

Source: Minimally Invasive Aortic Valve Surgery http://www.umm.edu/heart/aortic_valve.htm#noA#ixzz2WWWqvVZp
University of Maryland Medical Center
Follow us: @UMMC on Twitter | MedCenter on Facebook

Find a Doctor that you can trust and is experienced. The Doctor that operated on me has been doing minimally invasive procedures since 2007.

Mike
 
My AVR was done with a mini thoracotomy, about a 3 inch incision, and I was most pleased not to have had my sternum broken.

A while back someone here said the thoracotomy is more painful healing. I don't know because I don't have a sternotomy to compare it to, though, cutting through muscle supposedly causes more pain healing than a broken bone.

I would describe the pain after my surgery was minimal. I noticed soreness once I was home and doing things like reaching to get a dish out of a cabinet.
 
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Hi Luana,
How long ago did you have your surgery? How long were you in the hospital? What about your recovery time?
 
I had my AVR done by traditional full sternotomy. I really had no choice, as I needed a single bypass while we were at it. My surgeon said that the pain of recovery is really no different between partial and full sternotomy. As long as the wires are tightly holding the bone together, it is pretty solid and really didn't hurt during recovery.

BTW, scars are very unique to each patient and surgeon. Even with a full sternotomy, my scar is only about 3-4 inches long. They made the cut on a slight angle so that even if I have the top couple of buttons of my shirt open, the scar doesn't show. Just talk with your surgeon and make your wishes known. Usually they will try to do as you ask.
 
Thanks for your comments. My had 2 OHS a long time ago (he is now deceased) but I can remember long scars - I guess this type of surgery has come a long way. I don't know which type of surgery I will have because I am just entering phase 2 - selecting the surgeon and hospital. My primary says I should have a TEE first to determine the extent of the closure and I don't know if this is common. I had a TEE done 10 yrs. ago and that's when they diagnosed mild aortic stenosis. Did you ever have one?
 
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