Difference between ohs and minimally invasive avr

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almost_hectic

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Size of incision is the major difference. Lower risk of infection, potentially less pain/trauma and potentially quicker recovery. And since only certain surgeons are qualified in minimally invasive you might say you get a better, more skilled surgeon.
 

Geofd

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I just had minimally invasive mitral valve repair surgery, there was a guy next to me after surgery, he had open heart, he was walking and sitting in a chair pretty quick, I have an incision about 3"??? Long under my arm,and other puncture wounds
There was pain but nothing over the counter pain meds would take care of, the wound site still burns I guess, after a month sleeping had been tough but all easier than open heart I'm sure
 

nobog

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Nothing is free. All above is true but working through a tube (minimally invasive) has its challenges over OHS. Simply put - access. I can tell you from being a mechanic, having things right in front of you on a work bench vs working from under a hoist into some dark crevasse are two different things - and the same analogy applies to installing a heart valve. If it were ME, and I was in reasonable shape, I would take the OHS.
 

pellicle

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this seems like a good roundup

I would say that I'd want to look at 10 year data too ... you know, not just how much money the systems saves. Stuff like valve insertion angles, incidence of paravalvular leaks, effects on longevity of tissue prosthesis ... the usual stuff.

Myself I'm conservative, but either way there was no possible way that my last OHS could have been done with minimally invasive. Approaching 10 years on and I'd expect everything to be fine for the next 10 years (or 30)
 

Unicusp

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Any difference in out for both this method?
Very brief summary. More detail in one of my older previous posts. Having had minimally invasive "key hole" mini-sternotomy for ascending aorta repair in 2013 and traditional full sternotomy OHS this past February for aortic valve replacement (On-X), I recommend full traditional. The only downside is a longer scar, but that is temporary. Other than that, less pain and less issues afterward. I have no regrets having chosen the On-X over the Inspiris. The key to success is your surgeon and surgical center. My comparison is consistent as I had the same surgeon and center for both surgeries. Good luck with your decision.
 
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Paleowoman

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My surgeon had me down for minimally invasive AVR but went on to do a full sternotomy as she couldn't gain access to my aortic valve with minimally invasive. Minimally invasive is a smaller incision down the sternum, and the other is longer incision down the sternum. Both are OHS.
 

Geofd

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My Dr told me he would do what ever method I wanted, he would even replace the valve with my choice of valves, or make the repair from my ribs,
He did say it was a little harder to see , one of the tools, that he used was a camera, I asked alot of questions here and on another site,and all recommended minialiy invasive route, you just have to go with the info you have and your gut
 

Patrick2018

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My Dr told me he would do what ever method I wanted, he would even replace the valve with my choice of valves, or make the repair from my ribs,
He did say it was a little harder to see , one of the tools, that he used was a camera, I asked alot of questions here and on another site,and all recommended minialiy invasive route, you just have to go with the info you have and your gut
Has anyone had minimally invasive surgery for the repair of a prosthetic mitral valve? my cardiologist is currently working out what procedure would be best for my mitral stenosis in my bovine valve.
 

pellicle

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Has anyone had minimally invasive surgery for the repair of a prosthetic mitral valve? my cardiologist is currently working out what procedure would be best for my mitral stenosis in my bovine valve.
I'm not sure of your age, but why not just a standard operation and a mechanical mitral valve from someone such as St Jude?

If your bio here is correct you only got two years from that valve (which I'm sorry to hear). It also shows you are on "blood thinners" which I presume is warfarin.

Best Wishes
 

Patrick2018

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I'm not sure of your age, but why not just a standard operation and a mechanical mitral valve from someone such as St Jude?

If your bio here is correct you only got two years from that valve (which I'm sorry to hear). It also shows you are on "blood thinners" which I presume is warfarin.

Best Wishes
Thank you for replying, I’m just upon three years with my bovine mitral valve. I am taking warfarin and expect to hear sometime this week what procedure will be performed. I’m 68 years old and I had a very difficult time three years ago with my OHS. I have been researching methods such as transcatheter valve replacements. They apparently are very successful. I will make a decision based on the method my cardiologist comes up with. I am willing to travel to have a procedure arthroscopically or via transcatheter, rather than OHS.
Thank you
 

pellicle

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Good morning from Australia Patrick
...I’m just upon three years with my bovine mitral valve. I am taking warfarin and expect to hear sometime this week what procedure will be performed. I’m 68 years old and I had a very difficult time three years ago with my OHS.
yes, it can indeed be difficult. It is a very major surgery and should not be taken in a flippant manner.

I have been researching methods such as transcatheter valve replacements. They apparently are very successful.
ok, some points to look at very critically when reading:
  • define success (for instance from whos' perspective, the surgeon or yours)
    • successful over what duration (5 years, 10 years?) and factor that into your expected (projected?) lifespan
    • successful as a valve in valve or as a first time operation
    • in the mitral position or the aortic
  • your present state of health and the state of health you had before your surgery 2 years ago
  • can you tolerate an OHS now or are you high risk?

I will make a decision based on the method my cardiologist comes up with. I am willing to travel to have a procedure arthroscopically or via transcatheter, rather than OHS.
Thank you
you're welcome and I hope that it all comes out well.

Best Wishes
 

carolinemc

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Nothing is free. All above is true but working through a tube (minimally invasive) has its challenges over OHS. Simply put - access. I can tell you from being a mechanic, having things right in front of you on a work bench vs working from under a hoist into some dark crevasse are two different things - and the same analogy applies to installing a heart valve. If it were ME, and I was in reasonable shape, I would take the OHS.
No one said the surgery was free. we all pay for it. But the difference of the surgeries is the healing time. Especially of the Cracked Chest Muscle pain. If the aortic valve was not so invasive, I would go with the less invasive option.
 

nobog

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No one said the surgery was free. we all pay for it. But the difference of the surgeries is the healing time. Especially of the Cracked Chest Muscle pain. If the aortic valve was not so invasive, I would go with the less invasive option.
Have you ever seen a 1mm diameter "leakage jet" from a paravalvular leak? If you have you would understand the significance of such an event. Trying to seal 360 degree around the perimeter of a sewing cuff is not trivial - especially "minimally invasive". Yes - it can, and is done, but I would want to tip everything in my favor on a once-and-done (hopefully) operation.
 

vitdoc

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Sometimes there are real breakthroughs in technique or technology that make a big difference in medicine. Other times there are lesser differences that may on the surface look good but may be a bit over hyped. In my field of ophthalmology there have been over the years small changes in techniques that have been way overhyped. For example in the past cataract surgeons promoted cataract surgery with "no stitches". This was in distinction of those that closed a very small opening with one stitch (10-0 nylon very small). Essentially there was no real difference to the patient either way other than promoting those that touted the no stitch technique. And in some cases the one stitch people might have an advantage because sometimes the small wound would gape and infections would occur with the no stitch patients. So one has to try to separate the significant advances from the lesser ones. Also as mentioned having less access sometimes can be detrimental. In everything in life there is competition and hype even medicine. It is tough for the layman to really be able to separate significance from a bit of hype.
 

carolinemc

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Have you ever seen a 1mm diameter "leakage jet" from a paravalvular leak? If you have you would understand the significance of such an event. Trying to seal 360 degree around the perimeter of a sewing cuff is not trivial - especially "minimally invasive". Yes - it can, and is done, but I would want to tip everything in my favor on a once-and-done (hopefully) operation.
I have only two double bypass, one was repair in 1973, and replacement of the aortic valve in 2001, both cracked the chest the old fashioned way. Never heard of what you commented, but can be true. Do not want another surgery unless it is to be over, no more.
 

carolinemc

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Sometimes there are real breakthroughs in technique or technology that make a big difference in medicine. Other times there are lesser differences that may on the surface look good but may be a bit over hyped. In my field of ophthalmology there have been over the years small changes in techniques that have been way overhyped. For example in the past cataract surgeons promoted cataract surgery with "no stitches". This was in distinction of those that closed a very small opening with one stitch (10-0 nylon very small). Essentially there was no real difference to the patient either way other than promoting those that touted the no stitch technique. And in some cases the one stitch people might have an advantage because sometimes the small wound would gape and infections would occur with the no stitch patients. So one has to try to separate the significant advances from the lesser ones. Also as mentioned having less access sometimes can be detrimental. In everything in life there is competition and hype even medicine. It is tough for the layman to really be able to separate significance from a bit of hype.
Layman knows a heck of a lot more than you think. And they tend to do more research to learn more about surgical techniques. And do compare OPS to cataract surgery that is done by laser for the last 30 plus years. Before that, they use surgical knife and cause scaring damage to the eye. Laser is used these days. And it is also being used in OPS.
 

vitdoc

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Layman knows a heck of a lot more than you think. And they tend to do more research to learn more about surgical techniques. And do compare OPS to cataract surgery that is done by laser for the last 30 plus years. Before that, they use surgical knife and cause scaring damage to the eye. Laser is used these days. And it is also being used in OPS.
You inadvertently proved my point. In the US cataract surgery for those over 65 is covered by Medicare. Medicare pays something like $600 to a cataract surgeon. This includes seeing the patient for the next 90 days. Not a stellar amount for the skill involved in my opinion. However, if the surgeon goes outside the "standard" surgical procedure then the price for the surgery can be anything the market will bear. So for example if a laser is used to initiate the surgery the price could easily be $2000-3000 per eye or more. Now if the gain by using the laser was significant then that would seem reasonable. But the gain probably is insignificant. I know of a very skilled cataract surgeon who has access to a laser but eschews it. He feels that the extra complexity and time involved did not justify using it and he does his surgery without it and gets excellent results. He made this decision after using lasers for a period of time.
So unfortunately no matter what people would like to think money has a sneaky way of insinuating itself in many decisions. Words like laser, stem cells, holistic etc. are often used to make things seem better than they really are. Occasionally there are real significant advances that make a difference. The heart lung machine, the use of pyrolitic carbon in valves (St. Jude On-X) , vascular stenting, and now maybe the placement of valves without open surgery. But many other things are just another way to accomplish the same thing.
 
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