How to find surgeons and hospitals that perform minimum invasive aortic surgery in CA

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clawie1

Well-known member
Joined
Jun 9, 2013
Messages
72
Location
Torrance, Ca
After talking to my own daughter who is an internist, the bottom line seems to be cardiac surgeons prefer the standard open heart surgery for aortic valve replacements because it has been around for years, they have expertise and feel comfortable performing this surgery, so consequently it has become the gold standard. After reading a few posts in the forum, there are a few of you who have had surgeons perform min. invasive surgery and many of you are very pleased with the outcome. How did you find these surgeons? How did you find the hospitals that perform these? I live in So. Calif. and I am having a difficult time researching finding answers.

My other question is if I cannot find a local hospital or surgeon and have to go to another state, what is involved in the transportation back home and follow up from local cardiologists?
 
... the bottom line seems to be cardiac surgeons prefer the standard open heart surgery for aortic valve replacements because it has been around for years, they have expertise and feel comfortable performing this surgery, so consequently it has become the gold standard.

my wife always baked breads and cakes the way she knew because she ruined less that way.

seems reasonable to apply this same view to things which you can't just toss in the bin.
 
You just have to google drs who do the minimally invasive AVR in Ca an see what comes up. My Dr. (Dr. Glenn Barnhart) does the minimally invasive surgery here in the Seattle area. I thought at first I was a candidate but due to some weird routed arteries it wasn't possible. You might also just call the surgeons offices in your area and just ask if they perform the minimally invasive AVR. Good luck with your search.
 
Whether minimally invasive surgery is a good choice or not depends very much on what has to be fixed. The mitral valve is often a good candidate whereas the aortic valve is not. For the surgeon minimally invasive means less exposure, less overview, technically more demanding, long instruments and often a longer operating time. In order to connect the heart lung machine additional incisions in the groin and the right upper thorax may be necessary. Cardiac surgery is already extremely demanding but minimally invasive procedures push the limit even further and also the risk for error. The benefit for the patient is only that the sternum heals a bit faster.
Cardiac surgery isn't about the scars you can see on the outside, it's about what was done in the inside. I would want my surgeon to put all his effort into the valve surgery and the repair of the problem rather than into the long instruments, the bad light and the minimal exposure.
 
I am 14 weeks post op from standard open heart surgery. I did not even think of the possibility of minimally invasive surgery. My surgery was very complex and I was in the OR for 9 hours. My surgical process included Deep Hypothermic Cardiac Arrest. My point is that I am beginning week four back at work. I went through very complex surgery and I am pretty much fully recovered. My life has not been adversely affected in anyway. I am adjusting to coumadin just fine. I was blessed that my doctor's and surgeon were kind of destine to be my health care providers. I feel very fortunate. :thumbup: I highly recommend Dr. Bavaria at Penn if you have to travel he is excellent!
 
Tirone

Thank you for this perspective. Bottom line is I am 73 years old, only had surgeries below the knee (bunions, etc.), a widow, and quite frankly the thought of having my whole chest cracked open is frightening for me. Somehow I thought the recovery was faster and with less pain. Yes, I am scared. I can understand your point of view though.
 
Good grief, no need to travel for your surgery.

First thing I asked the surgeon, when I met him after cardiac cath, was if he could do minimally invasive, and I did not want a smaller sternotomy. He ordered a CT scan and results showed I'd be a good candidate. I PMed you more info.
 
Whether minimally invasive surgery is a good choice or not depends very much on what has to be fixed. The mitral valve is often a good candidate whereas the aortic valve is not. For the surgeon minimally invasive means less exposure, less overview, technically more demanding, long instruments and often a longer operating time. In order to connect the heart lung machine additional incisions in the groin and the right upper thorax may be necessary. Cardiac surgery is already extremely demanding but minimally invasive procedures push the limit even further and also the risk for error. The benefit for the patient is only that the sternum heals a bit faster.
Cardiac surgery isn't about the scars you can see on the outside, it's about what was done in the inside. I would want my surgeon to put all his effort into the valve surgery and the repair of the problem rather than into the long instruments, the bad light and the minimal exposure.
I had an AVR with a mini throcotmy. Sternum was not cut, even minimally. Not everyone is a candidate, and not all surgeons are skilled to do this approach. Mine was and he did a super job.
 
Whether minimally invasive surgery is a good choice or not depends very much on what has to be fixed. The mitral valve is often a good candidate whereas the aortic valve is not. For the surgeon minimally invasive means less exposure, less overview, technically more demanding, long instruments and often a longer operating time. In order to connect the heart lung machine additional incisions in the groin and the right upper thorax may be necessary. Cardiac surgery is already extremely demanding but minimally invasive procedures push the limit even further and also the risk for error. The benefit for the patient is only that the sternum heals a bit faster.
Cardiac surgery isn't about the scars you can see on the outside, it's about what was done in the inside. I would want my surgeon to put all his effort into the valve surgery and the repair of the problem rather than into the long instruments, the bad light and the minimal exposure.


Excellent post. I so agree.
My surgeon briefly spoke with me my second surgery about minimally invasive and I told him I was fine with full sternotomy again. I wanted him to have the best view, room to work and re-opening of my sternum was going to provide that.
 
I had a mini-sternotomy on 6/6 for AVR and aorta repair. As my surgeon warned me, due to aorta repair, my "zipper" is pretty high on my chest. Even without cosmetic benefits, my surgeon prefers minimally invasive surgery as he thinks in skilled hands it is faster and results in less scar tissue. My surgery was about 2.5 hours, so I can attest to the "faster" part.

While there was certainly a time when minimally invasive surgery was the new new thing, that time was more than 10 years ago. My surgeon has done hundreds of these procedures.

Anecdotally, I feel like my chest is more stable than I expected. I was able to lay on my side my first night home. Never having had a full sternotomy, I can't tell if this is me or the procedure.

My surgeon was 3.5 hours from my home. I was given a referral to him by my local cardiologist. Adam Pick's website also has listings for surgeons, but I believe they can pay to be listed, so make sure you do more research.

Best of luck in making your decision. -- Suzanne
 
I remember a question that came up during a Cleveland Clinic webchat...something to the effect of when is it advantageous to use a minimally invasive approach for aortic valve replacement and why. The answer touched on most of the comments above and was basically this: "It depends on the patient and it depends on the surgeon...there is no definitive answer."

Minimally invasive may have been around for awhile, but going with experience seems to still be very very important. My surgeon told me not quite 3 years ago that according to the national database operative stroke risk is higher with minimally invasive and that's why he would not yet recommend it, despite the other advantages it brings such as reduced blood loss and risk of infection, plus also quicker recovery. Yet, at the same time, I've seen a few selected retrospective studies (obviously from those with a lot of experience) that have indicated complications generally equal across the board, and even lower stroke risk in some cases with minimally invasive.

So, it seems pretty likely that the more experience a particular surgeon and heart center have with minimally invasive the better the results, so when a place like Cleveland Clinic makes it their "standard" surgical method, as is now true, I would assume that their results must have proven that at least for them it is in fact now the best option, with the lowest overall risk. It could be a completely different story at a less experienced center, though.

Also, keep in mind that not all risks are necessarily equal, depending again on the patient. It would probably be a good idea to ask each potential surgeon to be as specific as possible to your situation and your anticipated risks when comparing the minimally invasive option to a full sternotomy. In other words, don't just accept a recommendation for minimally invasive because that's what they do and think is best, ask what specific risks, if any, will be higher with that decision, and what specific other benefits there are informing their preferred technique and recommendation.
 
I had a mini-sternotomy on 6/6 for AVR and aorta repair. As my surgeon warned me, due to aorta repair, my "zipper" is pretty high on my chest. Even without cosmetic benefits, my surgeon prefers minimally invasive surgery as he thinks in skilled hands it is faster and results in less scar tissue. My surgery was about 2.5 hours, so I can attest to the "faster" part.

While there was certainly a time when minimally invasive surgery was the new new thing, that time was more than 10 years ago. My surgeon has done hundreds of these procedures.

Anecdotally, I feel like my chest is more stable than I expected. I was able to lay on my side my first night home. Never having had a full sternotomy, I can't tell if this is me or the procedure.

My surgeon was 3.5 hours from my home. I was given a referral to him by my local cardiologist. Adam Pick's website also has listings for surgeons, but I believe they can pay to be listed, so make sure you do more research.

Best of luck in making your decision. -- Suzanne

This makes me feel better. If the surgeon rules out min. invasive surgery for whatever reasons, I have to accept that but at least I know this is an option.
 
hi!
it often helps to hear of surgeons on this site. word of mouth, number of folks who have use the surgeon and his/her experience in doing this surgery are important (how many he/she's done).
hopefully, more CA members will reply soon).
 
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While there was certainly a time when minimally invasive surgery was the new new thing, that time was more than 10 years ago. My surgeon has done hundreds of these procedures.

What a relief to hear from all of you that have had both types of surgery. Now that I am going into the planning stage, I am trying to do as much research as I can. It appears from the research that not everyone is a candidate for this type of surgery. If I find out I am a candidate (based on echos, angiogram etc,), I would certainly consider this option. Suzanne, I didn't know this option was available for more than 10 years. Being a "newbie" to this forum, I thought it was just introduced maybe within the last 5 years or less.

My surgeon was 3.5 hours from my home. I was given a referral to him by my local cardiologist. Adam Pick's website also has listings for surgeons, but I believe they can pay to be listed, so make sure you do more research.

Did you have a problem traveling back home? What about follow up? No problem with your local cardiologist?
 
The 3.5 hour drive home was not an issue for me nor was it too bad for my husband who was the driver. We appreciated that everyone at the hospital worked to make sure I was discharged in time to avoid the evening commute traffic.

Other than a bit of delay in getting an appointment scheduled with my local cardiologist, I had no issue transitioning from the out of town hospital to my local facilities. I might have been more concerned about the transition if I was needing to monitor my INR. I never had an issue that would have required me to call on my cardiologist sooner than my scheduled appointment.

My surgeon was fine with me following up by telephone.

That said, I live in a small town in central California about half way between UCLA Medical Center and Stanford. The most highly recommended local surgeon does less than 100 valve replacements each year.

Living in Torrance, one of the advantages you have is that there are lots of great options within a 2 hour driving distance.

If you haven't read it yet, you might enjoy reading Adam Pick's book about his valve surgery. As I recall he lived in Redondo at the time and choose to have his surgery at USC.

Best of luck in whatever you decide. -- Suzanne
 
Thanks Suzanne. A few of you have given me name of cardiac surgeons within so cal and I am so happy I joined this site. I remember when I first was first diagnosed with this condition some 10 years ago, I remember doing some research then and Adam's site came up. I think Adam is very young and had full open heart surgery - it was a very touching story. I will revisit the jAdam's site. In the meantime, I appreciate all the leads that are coming in.
 
I responded to this post and just realized it's from last year.

nlex, if you want to PM another member, just click on their name and you'll have that option. The forum will automatically send that person a note (if they are willing to accept messages).
 
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