mini stern/groin incision/AVR

[Juliemoon]

Hi,

I met with my surgeon, and was hoping for a mini stern b/c of quicker recovery time, shorter hospital stay, etc. He said that if I have a mini-sternotomy for AVR, that it requires making an incision in my groin. My former surgeon never mentioned this, and I was under the impression that groin incisions were made for angiograms, and TAVRS, but not during OHS for AVR. He also said that he thought that full stern was the way to go, because of easier access. Wondering if anyone out there has had a mini stern, and what your experience was. Thanks in advance.

 

[matty]

Hi Juilemoon.

I had a mini-sternotomy only because it was something my surgeon specialises in / always does. It is still a sternotomy which means the sternum is cut to access what it normally protects, so not sure what a groin incision is about. My incision is about 4 inches long from a bit below the clavicle to almost the bottom of my pectoral muscles. I was hoping the mini-sternotomy would mean that the sternum was not completely divided, allowing it to still be supported by it's original structure and not just the sternal wires in recovery. I asked my cardiologist after the surgery if this was true but she did not know and I haven't tried to find the answer since.

My experience in recovery has been quite positive compared to what others seem to experience. I have never had any pain in my sternal region. I dropped all painkillers while still in hospital after the surgery, and felt like I only really needed them in ICU. I did my first push up at 3 months with no discomfort, though I don't make push ups a habit. I do have some mild pain through the side of my neck up through the back of my skull that causes a little discomfort intermittently, and started at about 3 months but I don't know if that's from resuming normal physical activities after 3 months of muscle atrophy. I'm don't know if the positives I experienced are attributable the mini ... but that seems a likely reason ?

I think it would take more skill on the part of the surgeon for a mini avr, seeing my surgeon's gorilla size hands made me a little nervous. If the sternum is completely divided in a sternotomy and not in a mini, then that is a serious benefit to having the mini. I felt comfortable with my surgeon doing the mini and having restricted access because that is how he always does them, but you still end up with a scar that's similar to the full sternotomy.

 

[Juliemoon]

matty ,

Thanks for that info. I'm glad to hear that your recovery went so well! I have heard of many people experiencing back and neck pain after surgery. I already have it, so will expect more. I am worried about this surgeon's experience, and am off to see another surgeon in another city tomorrow. Wishing you continued good health and thanks again for your input.

 

[Zoltania]

I thought the groin incision was for the cannulas for the bypass machine. I had about a 1-inch groin incision along with my right-sided thoracotomy (not sternotomy of any type) incision, and that was for the bypass hookup.

 

[epstns]

I think Zoltania has hit it. The potential groin incision is for the bypass connections, if the main incision is too small to afford access.

When I discussed various less-invasive methods with my surgeon, he pretty much said he doesn't usually do them. He did offer me the choice if I qualified, but wanted to be sure he had the best possible access to do the job I hired him to do. I opted for full sternotomy, but it ended up not being open to choice anyway, as I also needed a bypass. He needed full access to do both the valve and bypass.

I guess he did take my inquiry seriously, though, because I had a full median sternotomy (sternum cut and fully separated down the center line), but my incision is only about 4 inches long. He even ran the incision on a slight angle so that I can still wear open shirt collars without my scar showing. (I have no concern about my scars showing, though. I see them all as badges of courage. When a guy at the gym asked about the sternal incision scar, I told him it was from a knife fight I almost lost.)

 

[Jamieann]

I had a minimally invasive AVR, although not a mini sternotomy. My incisions were through my upper right chest (about 3 in long) and my left hip/groin (also about 2-3 in). My surgeon specializes in minimally invasive and I think it really improved my recovery time since I wasn't also recovering from a split sternum. That being said the incision did cause some weird numbness/nerve damage to my chest. My surgery was fairly straight forward, I know if there are different issues they are dealing with they sometimes shy away from minimally invasive.

What my surgeon didn't tell me is that in addition to my chest and groin incisions there were a couple other tiny ones near my right rib cage and then the one where my drain tube came out.

 

[drivetopless]

I also had a minimally invasive AVR (3 inch vertical incision over the sternum that starts about 3inches below the collar bone!) but I assume I also had the mini sternotomy as only the lower part had to be wired back together. I had a groin incision for the bypass machine. . .I wouldn't worry too much about the groin incision-- it healed quickly and didn't cause any issues post surgery.

I was only in the hospital 4 days. I still needed the pillow when I coughed for about 3 weeks post surgery. As far as pain, tylenol was really I all needed as long as I didn't use my arms too much.

I was really worried about the scar and made sure I found a doctor who understood my desire for a good cosmetic result since I was relatively young. I jokingly asked him to make it look like cleavage, which he thought was funmy. He never promised me a small incision and told me there were no guarantees if he found something else that needed fixing when he got in there he might have to open me up more. I just asked him to do the best he could with the incision. . I do believe the squeaky wheel approach helped. Post surgery, the nurses were raving about how small my scar was . .said it was the smallest they had seen .. . maybe he told them to say that.

I think if you want a mini-sternotomy for cosmetic or recovery time and dont have any other underlying issues that might require a bigger incision (repair of clogged arteries, anuerysm) than find a doctor who is experienced and comfortable with that approach and ask for what you want.

6 years post surgery-- I dont even think about my scar anymore.

 

[Juli]

Hi Juilemoon.

I had a mini-sternotomy only because it was something my surgeon specialises in / always does. It is still a sternotomy which means the sternum is cut to access what it normally protects, so not sure what a groin incision is about. My incision is about 4 inches long from a bit below the clavicle to almost the bottom of my pectoral muscles. I was hoping the mini-sternotomy would mean that the sternum was not completely divided, allowing it to still be supported by it's original structure and not just the sternal wires in recovery. I asked my cardiologist after the surgery if this was true but she did not know and I haven't tried to find the answer since.

My experience in recovery has been quite positive compared to what others seem to experience. I have never had any pain in my sternal region. I dropped all painkillers while still in hospital after the surgery, and felt like I only really needed them in ICU. I did my first push up at 3 months with no discomfort, though I don't make push ups a habit. I do have some mild pain through the side of my neck up through the back of my skull that causes a little discomfort intermittently, and started at about 3 months but I don't know if that's from resuming normal physical activities after 3 months of muscle atrophy. I'm don't know if the positives I experienced are attributable the mini ... but that seems a likely reason ?

I think it would take more skill on the part of the surgeon for a mini avr, seeing my surgeon's gorilla size hands made me a little nervous. If the sternum is completely divided in a sternotomy and not in a mini, then that is a serious benefit to having the mini. I felt comfortable with my surgeon doing the mini and having restricted access because that is how he always does them, but you still end up with a scar that's similar to the full sternotomy.

Matty - I had a very similar experience with my mini-sternotomy. Was on pain killers for one day only and then switched to just Tylenol. First half day at work after 10 days, back at work 2.5 weeks post op. Was able to walk for 1-2 hours 6 days post op, back riding my bicycle after 6 weeks, mountain biking after 8 weeks. I had a 4 inch incision and the surgeon used plates as opposed to wire to put the sternum back together again. Plates provide a much better fixation and minimize pain and discomfort. For those of you that are planning surgery you might want to ask for such a procedure.