Invasive Vs. Minimally Invasive AVR

[jumpy]

This may not be a practical discussion as I cannot find anyone in Canada that does the minimally invasive procedure, but, what is the difference in recovery? It seems that quite a few of the recovery issues come from the sternum which I think may be the cause of the neck/back issues. Do those with minimally-invasive surgeries have these same issues? At the three month mark who would be more "back to normal"?

 

[Mentu]

Experiences can vary dramatically for individuals despite the type of surgical procedure. During my AVR last year my surgeon performed a sternotomy, however, as he closed instead of closing the sternum with wires he used 3 clamps. I experienced no deep chest pain even on my first day after leaving the ICU. In subsequent weeks, the discomfort I experienced came exclusively from irritating the chest muscles that were still in the process of healing. The point I would make is that even with a sternotomy it is possible to have little discomfort. As you hear from those who have had "minimally" invasive surgery, I think you will find a similar pattern. How quickly and painlessly you recover is going to be a function of the skill of your surgeon, of course, but much more it will depend upon your state of health at the time of surgery and the care you take with your recovery routine afterwords. Regardless of the type of incision your surgeon thinks would be best to use, I think your foremost goal should be to have the best recovery after surgery. I don't think it possible to predict how any individual is going to react to valve replacement but from what I've experienced your recovery will be faster and more complete if you work hard to make it so.

Larry

 

[Lynlw]

Larry made some good points and of course everyone is different and even for 1 person each surgery/recovery can be quite different, you never know in advance. but, by 3 months out, Many people are pretty much back to "normal" as far as day to day activity levels ect. no matter what kind of incision they had.
Also there are a few kinds of minimally invasive incisions, http://my.clevelandclinic.org/heart/disorders/mini_invasivehs.aspx os a good place to learn about the different types.

 

[hook]

They say the minimally invasive is more painful, but heals faster. I had the minimally invasive and thought it healed pretty fast, and the pain was not that big of a deal. To get a good answer you would need to find that person who has had both. The bad thing about going through the side is the right side of my chest is numb and sometimes tender.

 

[daveguy14]

I've had both--mini the first time, full the second. The second surgery was definitely tougher physically, which I can probably only partially attribute to the incision. I lost more blood the second time around, leaving me much weaker--this may be partially explained by the larger incision, but also because the reop was more technically challenging. The biggest difference for me was probably having four chest tubes the second time versus only one the first time, so the first couple days were a bit more uncomfortable. Once I got home, however, I was not in more pain or discomfort with the full sternotomy, and felt as well three months out as I did the first time. I hope that helps.

 

[deano89]

i had mitral valve repair my surgeon doesnt like minimal invasive and likens it to trying to paper your hallway through a letter box .you can do it but would you like the result, we are trying for a lifetime fix ! i can see exactly what he is saying and would op for full sterno every time i just think the more room you have to work the better the result in what ever you do ! , i had only discomfort and recovery was good for me walking 3mile at 6 weeks back doing light weights at 12 weeks and i would highly recommend the cardio rehab, if you google heart surgery live channel 4 frank wells you can see the surgery and read the question and answers session

 

[hook]

This decision may also depend on your surgeon’s skill and experience. My surgeon had done over a thousand mini procedures, so he told it was easy for him. You don't want this procedure if you are the third person he is learning on.

 

[daveguy14]

My concern about this would not be so much with the full sternotomy itself--it's a time-tested, safe way to do open-heart surgery. It's rather that the minimally invasive has been around for fifteen years and is now the standard of care for isolated AVR at good hospitals. I would worry what his inability to do the mini might mean about his skills as a heart surgeon overall and that he is not keeping pace with where the field is going.

I'd be shocked if nobody in Canada did the mini approach. Indeed, the Ottawa Heart Institute does, see here: http://www.ottawaheart.ca/clinical_overview/cardiac-surgery_2249.htm.

 

[Greg a]

This may not be a practical discussion as I cannot find anyone in Canada that does the minimally invasive procedure, but, what is the difference in recovery? It seems that quite a few of the recovery issues come from the sternum which I think may be the cause of the neck/back issues. Do those with minimally-invasive surgeries have these same issues? At the three month mark who would be more "back to normal"?

I am pretty sure London Health Sciences does as well as McMaster, and I think St Narys cardiac center is launching and of couse the Ottawa Heart institute AND I think maybe in Motreal at the Heart institute there....where in Canada are you ?

 

[Greg a]

articke from 2008

articke from 2008

CSTAR’s Expertise Provides Canadian Heart Surgeons with
Robotics Training

Tuesday, November 18, 2008

London, Ont. - Rapidly changing techniques in minimally invasive cardiac surgery are motivating an increasing number of cardiac surgery teams to learn and adopt new technologies and procedures. That’s what brought a multi-disciplinary cardiac surgery team from Montreal to CSTAR (Canadian Surgical Technologies & Advanced Robotics) to gain knowledge and expertise from Canada’s leading robotic surgeon.


Dr Bob Kiaii and the surgical team.

The two day education and training workshop focused on the work of Dr. Bob Kiaii, cardiac surgeon and director of Minimally Invasive and Robotic Cardiac Surgery at London Health Sciences Centre. Dr. Kiaii and his multidisciplinary team have achieved a number of significant milestones in robotic-assisted cardiac surgery including Canada’s first minimally invasive robotic-assisted mitral valve repair at LHSC (London Health Sciences Centre). The procedure, using the da Vinci robotic system, provides a minimally invasive alternative to conventional open heart surgery. Robotic cardiac surgery now comprises 80% of Dr. Kiaii’s practice with patients being referred to him from across Canada.


Under the mentorship of Dr. Kiaii and his cardiac surgery team at LHSC, the visiting cardiac surgeons and operating room nurses from the Montreal Heart Institute and Hopital Sacre Coeur were active observers of a live cardiac surgery case. In addition, the Montreal team practiced their robotic surgical and procedural skills for mitral valve repair within the simulated learning environment of CSTAR . This procedure is used to treat the narrowing or leakage of the mitral valve which is the “inflow” valve for the left side of the heart. “I believe that our successful visit will lead to future collaborations with Montreal, and has promoted CSTAR's initiatives in both training and education,” stated Dr Kiaii.


“We were able to appreciate the very intuitive nature of the robot”, remarked Dr. Michael Pellerin, Head of the Department of Surgery at the Montreal Heart Institute, “and practice advanced techniques in mitral valve repair”.


“CSTAR is very pleased to support Dr. Kiaii’s cardiac surgery team-based education initiatives and to host the team from Montreal Heart Institute and Hopital Sacre Coeur,” says John Parker, Director of CSTAR. “As these and other centres across Canada adopt robotic and other minimally invasive surgical technologies, we are witnessing a growing demand for multi-disciplinary team-based training and London is becoming the destination of choice for this type of programming.”

 

[Kathy McCain]

I had a mini sternotomy, which from my understanding is not really a minimally invasive surgery. For myself, unfortunately, I did not experience a faster or easier recovery. I had one of the best surgeons perform the surgery at the ST Lukes Heart Insititute. I was in very good physical shape for my age (56yrs) too. My cardio told me before the surgery, it is very hard to predict just how well, or long it will take a person to recover. It certainly does not hurt to be healthy, and in good shape though. Everyone heals differently, in spite of how it was done.

Make sure you get the best surgeon you can, and have a positive attitude. You will do well.

Take care, and keep us posted.

 

[Bob in Colorado]

I've had both too

I've had both too

I had a mini incision in 2000 for an aortic homograft. I needed to replace that tissue valve with a mechanical valve in 2009 and had a full sternotomy. My surgeon would not consider a minimally invasive approach for a second surgery. Everything went well, and though I was prepared for greater pain during the second surgery, it was not bad at all. Minimal pain and discomfort, walking a mile on day 3, out of the hospital within a week. Really a great outcome. A year later I feel terrific - though I am not as pretty as I once was