Mini-stenotomy vs full stenotomy AVR

[Johan]

I am now one week away from AVR surgery with the traditional full sternotomy. My surgeon does not believe in mini-sternotomies, not enough room to work in according to him. Last night met another surgeon at a social function and he tells me he does many mini-sternotomies for AVR. I now sit with two conflicting opinions. The mini-sternotomy obviously sounds better to me but then I do not want them to manipulate my heart too much because of a lack of space. Any thoughts out there, is a mini really so much easier to recover from afterwards? Johan

 

[john79t]

I am in about the same boat. Surgery scheduled for June 30. I am 61. Discussed the mini vs full with my surgeon who has done many AVRs. I also need a wrap done on my aortic root to srink it. He said the lack of work space , difficulty in getting back in to fix a possible bleed or other compilication plus just overall better results out weighted the small benifit of a little quicker recovery. I decided I wanted him to have the best work field to fix my problem.
What type of valve are you getting? I am going with the CEP Bovine.

 

[Johan]

John. Thank you for the post. I am leaning towards the full sternotomy for the same reasons you mentioned. You have given me some peace of mind, I shall now remain with my original surgeon and the full cut knowing that they have enough space to work in. After MUCH deliberation (what a selection process I went through!!) and a lot of help from this wonderful website, I decided on a bovine Carpentier-Edwards Perimount Magna, the same as you. Being both in our 60's I think we made a wise choice. My surgery is at 8 am on 1 July which should make it about 11 pm in Missouri on 30 June, you will then be through it already! The best of luck and may the dreaded vent tube not give you too much trouble! Johan

 

[sue943]

I was happier with the idea of a full sternectomy than I would have been with a mini, the more space they have to work especially if there are some complications then the happier I am. I don't mind the longer scar.

 

[john79t]

Hopefully I will be having a good recovery from my June 30 AVR while you are getting yours on the 1st.

 

[deek]

You never know what you will end up with. My surgeon told me that my incision would be about 2 inches and I ended up with an 8-9 inch incision (at least). Best of luck to you!

Dee

 

[realkarl]

Johan: I read your post in the other thread as well. and I am glad you are comfortable with the original surgeon and method, as well as not having to complicate your surgery more than needed with the CABG. Any change to these serious matters at the last minute is always stressful. I still have a whole month left to wait, and hopefully no changes or postponements. Good luck!

 

[Cooker]

Opinions are like ..... I had the full deal ... I have read that the recovery is about the same for both, I don?t know but I was very comfortable with them having all the room they needed to work .... best of luck....

 

[Reddog]

My surgeon told me that he had very little room to work, even with my entire sternum opened up. I am a big man, very "deep-chested", and apparently some hearts are deeper in the chest than others. It really can make a large difference in the difficulty of the operation. I am very glad that my surgeon had all the room he needed.

Red

 

[ALCapshaw2]

I had the Full Sternotomy and felt only some "discomfort" in my chest afterwards (both times). Back Muscle Pain was more of an issue after the AVR. MASSAGE was the Best Solution for the muscle pain.

Some have reported 'more discomfort' from the Mini-Sternotomy (and it depends on exactly which type of cuts the surgeon makes). There can be MORE stress (and Pain) at the end of the cut due to the prying open of your chest.

Having a Successful Surgery is priority #1. After your recovery is complete, you won't remember much about it. Just resign yourself to whatever time it takes to heal properly and don't 'push it'. Focus on having a Healthy Heart for the Rest of your Life and living that life to the fullest.

Best Wishes for a successful surgery.

'AL Capshaw'

 

[gerrys]

John. Thank you for the post. I am leaning towards the full stenotomy for the same reasons you mentioned. You have given me some peace of mind, I shall now remain with my original surgeon and the full cut knowing that they have enough space to work in. After MUCH deliberation (what a selection process I went through!!) and a lot of help from this wonderful website, I decided on a bovine Carpentier-Edwards Perimount Magna, the same as you. Being both in our 60's I think we made a wise choice. My surgery is at 8 am on 1 July which should make it about 11 pm in Missouri on 30 June, you will then be through it already! The best of luck and may the dreaded vent tube not give you too much trouble! Johan

Good choice on the valve and the procedure!

Best wishes to you both! Ask for the gold-plated valve. It's a little more expensive but adds a nice touch!

 

[Johan]

Thank you everybody, for the feedback and kind thoughts! I also contacted a senior surgeon at the Thoracic Surgery Unit at the University of Cape Town about mini vs full sternotomies. This is his feedback :"We did a whole series of mini-sternotomies in our Dept for Aortic valve replacements about 8 year ago and we really did not find much benefit in terms of less pain, quicker recovery or better cosmetic result compared to the standard procedure. It is technically somewhat more difficult. I still have the occasional patient asking me to do it for them. Internationally as well there was a period about 10 years ago when many units tried them and although there are many units that still do them as one of their preferred approaches I would estimate that less than 10 % of units still do mini-sternotomies in large numbers.
Good luck with your surgery."
This about summed it up for me. He was less enthusiastic about the gold plated valve, cannot stand vain patients!! Johan

 

[Kathy McCain]

I had a mini sternotomy , but I did have some complications. I had one of the very best surgeons. I said to him " I would prefer a mini, if you feel you can do it with no problems. He told me that it shouldn't be a problem, because my heart overall was in good shape. I also had no artery disease, and was not over-weight. The complication I had, several people on the forum had experienced too. I believe they had the median sternotomy though. Anyway, my heart and valve are doing great, so far!

Good luck on whatever you choose!

 

[dl_mooney]

I too want the Surgeon to have plenty of room to do the work thats needed. Also hope there are no problems that arise -heart not wanting to get back to work ,bleeding,Etc.