Is Minimally Invasive Mitral Repair Possible?

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danb1983

danb1983

Well-known member
Joined
Nov 6, 2008
Messages
94
Location
Darlington (nr Newcastle), England
Hi,

Someone just left a comment on my blog saying:
In England the Medtronics transcatheter delivery system has been approved.I t doesn't require open heart surgery. Is it available to you? It is a much less traumatic procedure and the recovery period is only a couple of days. Check out the Medtronics web site they have a video clip.

http://www.medtronic.com/our-therapies/heart-valve-repair-and-replacement/index.htm (I think this is the website, but I don't really understand it...)

This has really messed with my head, I would LOVE to have a less invasive procedure than OHS, but when I asked the question to my surgeon and nurse I was told that because it was the mitral valve and inside the heart this just wasnt possible... and then no more was said about it...

My background is that I had OHS to fix a hole in the heart aged 2, and I have had a mild leaking valve all my life, it is now severe so need a repair. It is not "diseased" as such, but a congential condition... I am also told that there is an 80% chance of repair, so a 20% chance of replacement. I am waiting for surgery at the Freeman Hospital in Newcastle, England....
... Are any of these reasons why the less invasive option won't work for me?

Any information would be greatly appreciated :)
Thanks, Dan
 
Damn, i completely forgot that they also want to do a procedure where they "burn / "microwave" my heart chamber, as one of them has swolen due to the palpitations / leak and this should stop further palpitations / complications.... I guess for that they would need to open me up properly...

... Can't believe I just FORGOT about that... My head is all over :) Wish they'd jsut give me a date and call me in! :)
 
There are several people from VR.COM that have had minimally invasive MV repairs. You need a surgeon who has done a lot of them, and then, of course, it depends on your particular situation, but definitely it is possible.
 
My surgeon offered me the choice for MI for mitral valve repair/replacement. This was my second OHS with the same surgeon and I was okay about doing the sternum route.....that was what I was familiar with and knew what to expect. My surgeon said, Good. He has more room to work with open chest but if I really wanted minimally invasive, it was an option.
 
danb1983 said:
Damn, i completely forgot that they also want to do a procedure where they "burn / "microwave" my heart chamber, as one of them has swolen due to the palpitations / leak and this should stop further palpitations / complications.... I guess for that they would need to open me up properly...

... Can't believe I just FORGOT about that... My head is all over :) Wish they'd jsut give me a date and call me in! :)
Click to expand...

I think what you're talking about is catheter ablation. Back in the day, they did need to open you up... but now it's just a catheter threaded through the femoral vein.
 
As DuffMan and Adrianne stated above, it is possible--it just depends on the circumstances surrounding your valve disease. I also had myxomatous (degenerative) mitral valve prolapse and had a repair done minimally invasively. I have a Medtronics annuloplasty ring attached to my anterior leaflet. Of course, this probably means nothing to you, but there are many surgeons who have done MI valve surgery on all kinds of candidates. It's best to explore all your options.
Best,
Debi (debster913)
 
I had a Maze Procedure for A-Fib (left maze actually). If I understand correctly, this can also be done by a minimally invasive surgery.
 
Actually, the mitral valve really lends itself to less invasive surgery. I had my mitral valve replaced via a heartport that was inserted through an incision on the underside of my right breast. The incision is smaller than a full sternum approach. It was still "open heart" since they had to enter the heart and cut out the bad valve and put in a mechanical but it may be worth your while to inquire about to your physician. He might be cool on the less invasive routes because he is uncomfortable doing them himself and there is quite a learning curve. If he can't then maybe he can refer you to someone who is adept at it.
 
You need to know that there are *several* different types of
"Minimally Invasive Heart Surgery".

For example:

A partial sternotomy where only a few inches are cut

A thoracotomy through the rib cage (right side for Mitral Valve). Dr. Petracek at Vanderbilt University in Nashville, TN does 200 of these every year.

I suppose the trans-catheter placement (of the Aortic Valve) could also be called a 'minimally invasive surgery'. This is typically only used on high risk or elderly patients in the USA at this time. A BIG issue would be how long the valve will last and how well it will perform (especially for a younger patient).

To get to the Mitral Valve through an artery, they would need to go through the Aortic Valve. I don't think anyone is doing that and probably won't ever do that since there would be a risk of damaging the Aortic Valve in the process.

'AL Capshaw'
 
One thing I wanted to add it that you need to make sure that you ask your surgeon a lot of questions about your minimally invasive surgery and the upsides and downsides. Often people come onto this board and assume that "minimally invasive" means that there will be minimal pain, minimal recovery time, and minimal complications. There have been individuals on this board who have had both minimally invasive surgery as well as the more standard sternum opening and have reported much more pain with the minimally invasive approach. The reason is that the surgeon needs to cut through a lot of muscle with all of the minimally invasive approaches while there is relavely little muscle cutting when they go through the sternum. If you have had a broken bone, you know that there is relatively little or no pain once the bone is reset until it heals. Compare that to an injured muscle pain (pulled, strained, etc.) and recovery and there is no contest. That said, it seems from my unscientific observations on this board that those who have a minimally invasive surgery have fewer restrictions (especially with regards to driving) immediately after surgery. One advantage of the full sternectomy is that it gives the surgeon the best access to the heart in case you have some complicating factors. I seem to recall that there has been at least one person on this board who went in for minimally invasive surgery, but the doctor ended up finding that things were more complicated than they thought and had to do the sternectomy as well to get better access - in that case you would get the downsides of both approaches and the upside of neither. The minimally invasive approach does, of course, offer cosmetic advantages. If you are a person who would feel extremely uncomfortable with a chest scar, that can be avoided. Regardless, please make sure you understand the pros and cons of each approach before making your decision.
 
Thanks for the quick replies, this forum is a godsend!

I think ill end up having the full open heart option I guess... I was hoping for a quicker recovery, and a better than 80% chance of getting a straightforward repair rather than a replace, I think im just over-thinking things and just want it all to be over with :)

If the survival rate is no better and the recovery isn't that much better then ill just stick to what I've been told... In my panic I already emailed my nurse about possibilities... Hope she isn't mad at me :p

Thanks everyone!
 
i just found it interesting and probably an insight into the future and as you say in UK all they tell me is they crack open the sternum as an only option. they dont even seem to consider minimal invasive surgery. i asked this at my hospital appointment when told surgery was required i asked about minimal and he just said thats not an option.no explanation but it is something i keep looking at
i suppose it makes sense when the sternum is open they get a much better look and ease to work as scary as i find this it does make sense.
 
Yeh, same with me, it wasnt up for discussion, I was just told it wasn't an option at all, I diddn't realise that some have had it at that time...

I agree, it seems logical, but scarier to have your sternum broken and your chest wide open :)
 
I guess at this point i am the forum's davinci promoter. I would at least see if this is an option for you over there. Trust me, anytime you can avoid having your breast bone sawed through, do it. Look into other options and consult other surgeons. Like everyone else has said, you really have to be your own health advocate and do what is best for you. I like to think that if i ever need another surgery, by that point they'll be able to do it with laser beams and not have to cut you at all :). surgery is advancing so much
 
ALCapshaw2 said:
To get to the Mitral Valve through an artery, they would need to go through the Aortic Valve. I don't think anyone is doing that and probably won't ever do that since there would be a risk of damaging the Aortic Valve in the process.

'AL Capshaw'
Click to expand...

Actually, the E-Valve procedure on the mitral valve is a transcatheter procedure. The only thing is that the E-Valve procedure is still experimental I think, and it just doesn't seem to me to be the ideal solution.
 
I have personally had 2 OHS. My first was MI and the second sternotomy. They were unable to repair the mitral valve through the MI. I think and other surgeons I have spoken to say it was because of the MI, there is not as good of a view. It has been over a year and I am still having issues with the nerves and muscles where they went through. WIth the sternotomy I have healed much faster with less pain.
 
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