Mini-sternotomy avr

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2leafer

Member
Joined
Dec 30, 2009
Messages
12
Location
Bend, Oregon
I am having my AVR done by Dr. Gillinov at The Cleveland Clinic where he will be performing the procedure minimally invasive via a "mini-sternotomy". I am aware that this is better because of less trauma and bleeding, less pain, and a faster recovery. I would like to know if anyone has had their aortic valve replaced in this fashion and how it went for them after the procedure and during recovery. Thanks!
 
I'll be watching for the answers you get. I'm hoping to take this route when the time comes for me too. :) I know there are at least a few folks around who had a "mini," just not sure if it was aortic or mitral. I think the forum is a bit more quiet on the weekend so hang tight.
 
I had a mini at Cleveland Clinic for my AVR. Incision ended up being about 5 inches long. I don't have a frame of reference to compare the type types of procedures (and hopefully never will). What I can tell you though is just because its called a "mini" don't fool yourself into thinking you will be doing cartwheels down the hall after surgery. Its the same truck running you over but maybe it was going a little bit slower.

I was in very good shape going into surgery and I think that factored into my recovery. I was back at work after 5 weeks (desk job) and actually played 18 holes of golf after 8 weeks. I can tell you I probably needed another week at home before I went back to work. And while I did play 18 holes at 8 weeks I paid for it for the next 3 or 4 days with soreness.

I definitely think you will bounce back a little faster because they don't have to completely cut the breast bone. But beyond that your going to have the same recovery path and limitations. My biggest prayer for anyone going into this procedure is that they don't have any type of cold post surgery for 3 or 4 months. One sneeze or cough and you will understand why :)
 
2leafer....I will be out your way this summer. I used to live in Portland and have camped outside of Bend (Pauline Lake). The wife and I are flying to San Fran and then driving up to Porland with various stops on the way. We plan to hike all 3 of the sisters. I can tell you that there is no way I could have done that pre-AVR. Your gonna be amazed at how much better you feel when your done with this mess.
 
I was VERY lucky. No sneezes or coughes at all for 6 weeks. When I finally did sneeze it still hurt some. I don't remember who but I do remember during my recovery there was someone else on the same timeline as me. That person contracted a fairly serious cold right after surgery and did nothing but sneeze and cough for pretty much the length of the recovery. I just remember reading those posts and thinking "please please please ! don't let me catch a cold !!!!"
 
glad you posted cytguy. I also had a mini at CC. I have no way to compared also but even though i was back to work at 8 weeks the first month out surgery it was painful. I think at week 3 or 4 i started to feel a little better where i was off the pain meds and able to do little things around the house. But the back pain i had from the surgery lasted longer. It probably took me at least 3 weeks to be able to sleep through the night without having to get up to take some pain meds.
 
I didn't have a mini but the regular fare at Mayo and I didn't find it to be too bad. I was back at work in 5 days (professor) and off pain meds in less than 3 weeks. That said I did have to be careful opening doors and sneezing for a month or more.

Since I'm having to think about surgery again (not this month, but maybe this year) I'm wondering about asking about a mini. Last time I asked the surgeon, he said he could do it, but said my case was more complicated and would take more time. He recommended going with the regular because it would be less time on heart-lung bypass because the access would be easier for him. Anybody know if this generally true or just true for him?

traveler
 
I had the mini done at St Lukes's Heart Insitute. I hate to report that I had a very rough time indeed! Had a blood transfution (three pints). I also develped effusion one week after the surgery. Was not home 24hrs and had to return to the hospital for a pericardial window. Appox 2 wks after that developed pericarditis, which I am finally (maybe) believe it or not, almost over with! At present still on 2 1/2mg prednisone for this. I must stress however, EVERYONE IS DIFFERENT! I guess my body does'nt take kindly to being invaded! (ha)
 
Oh yes, a cough post surgery, may be a symptom of effusion too. Coughing of course, you absolutely want to try and avoid. It hurts like the dickens!
 
I also wanted to mention, with SOME mini they can't hook you up to the bypass (heart/lung machine) in the main incision, like they normally do, because there is not enough room ect. So they have to make another 2-4 inch incison for it and use either the groin area or corotid (kind of neck/collarbone area) That can be painful and if they use the groin area,(and at least in Justin's experience) hurt when you are walking ect the few few days. Justin had a full sternal incision but needed the groin bypass and for him, he said the leg botherred him more than his chest did.

Now I don't know which minimally invasive procedures need the extra incision for bypass and which don't but I think that would be a good question to ask. Some people seem to be a little surprised. I also don't know how they decide which spot to use, during the pre op tests when Justin MIGHT need it, they do ultra sounds of both sides of his neck and groin, he told the doctors IF they could use either place he would prefer not to use the neck, because he didn't want another visible scar.
 
Mini = limited access

Mini = limited access

I didn't have a mini but the regular fare at Mayo and I didn't find it to be too bad. I was back at work in 5 days (professor) and off pain meds in less than 3 weeks. That said I did have to be careful opening doors and sneezing for a month or more.

Since I'm having to think about surgery again (not this month, but maybe this year) I'm wondering about asking about a mini. Last time I asked the surgeon, he said he could do it, but said my case was more complicated and would take more time. He recommended going with the regular because it would be less time on heart-lung bypass because the access would be easier for him. Anybody know if this generally true or just true for him?

traveler

I discussed this option with my surgeon prior to my AVR and he explained that the Aortic Valve is tougher to reach than the Mitral, on which more minis are performed, and that should a problem arise during surgery, the response would be more complicated with a smaller access area. This seemed very logical to me and convinced me to go with the regular sternotomy.
 
Yep, I was told that my surgery would be a mini too. After waking up the next day I noticed that my scar was a bit longer than I thought if would be. My wife told me that I had 2 separate bouts of internal bleeding after my valve replacement. I went in for surgery two extra times after my replacement surgery. So my mini turned into a full sternotomy to stop the extra bleeding. I believe my surgeon stated something like 2% of valve replacement surgeries have internal bleeding complications. I guess I was one of the unlucky ones.
 
I had a mini 4 weeks ago. I don't have anything to compare it to, but mine was no walk in the park. Enough pain for me, I can tell ya that. Still on pain pills and just now starting to be able to sleep on my side. Incision looks fine even though a couple of stitches were not gotten out. Gotta go on Friday to see my surgeon and have him pull them out. Good luck!
 

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