Minimally Invasive Mitral Valve Repair/Replacement?

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Cooper

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Anyone? My husband is facing mitral valve repair and deciding between surgeons and surgical technique. Some surgeons offer minimally invasive; others do it the traditional way. I'd be interested to know if anyone has chosen minimally invasive mitral valve repair or replacement and what your experience was like. If you've had both (traditional and minimally invasive), I'd be interested to hear your comparison.

Did you have pain at the incision site and for how long?

Where did they connect heart/lung machine? Same incision or different incision near groin?

Any complications at all?

How long before you were up and walking?

Full recovery time?

Do you feel that you got a good repair? Specifically, is it holding? Do you have any regurgitation after your repair?

Do you feel your surgeon could've given you a better result by doing surgery the traditional way?

Thank you so much!

Cooper
 
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labguides

Guest
Our daughter had right mini thorcotomy (incision under the right breast). She definitely had pain. She was afraid to use her right arm, so she needed PT. Complication was problem with lung re-inflating. She had pleural effusion, which was the most painful part.
She was up and walking 24 hours after surgery.
Her surgeon did not mention any other type of incision.
Her surgery was a complete success!
 

Nancy

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upstate New York
My husband's third surgery was to repair a small paravalvular leak around the suture area of his mitral valve and was done using the HeartPort method through his side. It was done this way to spare him another sternum opening, since he had had two already.

His initial recovery was shorter than with a sternum opening by a few days, and he did not have bone healing to cope with, so that was good.

The groin incision was painful, and there are a couple of other incisions in the side and under the breast area which were soft tissue healing and very sore.

What goes on inside the heart is about the same, so the longer term healing is about the same 6-8 weeks to feel pretty well, then the rest of the healing takes place slowly over the rest of the year.

With both types of surgery he was up and moving around within two days or so, and was home in 5-6 days.

His repair is fine now.

However, Joe did not need a complete valve repair such as fixing leaflets or putting in a ring around the annulus, etc. I'm not sure he would have wanted the minimal surgery in that case, since his internal heart structure is difficult due to an old and large aortic mechanical valve and mechanical mitral.

Always be prepared for the fact that minimal surgery can be converted to regular surgery during the course of the operation if it is necessary. And a repair may not be possible once the surgeon actually sees the nature of the valve, and a new valve may be needed.

So be flexible in your thinking. Go with the surgeon you like and respect, and trust their judgement.
 

MelissaM

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Boulder, CO
I had a minimally invasive procedure done at the Cleveland clinic. They doglegged in through the 3rd intracostal space, cut down the breastbone, then doglegged out through the 5th intracostal space.

Did you have pain at the incision site and for how long? Yes, for about six weeks. But I felt because parts of my sternum were still naturally intact, those parts supported the parts that had been disturbed.

Where did they connect heart/lung machine? Same incision or different incision near groin? Normal connection to hearl/lung machine - only on it for 56 minutes, though. Incision was 2.5" down center of chest.

Any complications at all? Pleural effusion & Supraventricular tachycardia (arrythmia)

How long before you were up and walking? Next day.

Full recovery time? Gosh, there are so many levels of recovery. . .

Do you feel that you got a good repair? Specifically, is it holding? Do you have any regurgitation after your repair? Got a great repair. Just had an echo 1.5 years out and the doc said it was functioning very, very well. He siad it was a good repair. There is trace reguge, which is normal.

Do you feel your surgeon could've given you a better result by doing surgery the traditional way? If there are complications, the might have to open you up all the way. There is some debate as to whether or not my effusion and SVT would have occured. But if I had to do it over again, I would pick minimally invasive all over again.
 

DuchessBear

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Aug 12, 2002
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Fairfax, Virginia
I had my mitral valve replaced by minimally invasive surgery. The surgeon went in between the ribs just under my right breast -- no cutting of any bone. The incision is about 4" long, and there were 2 1" incisions under that for the drainage tubes. And somehow, in that little space, they managed to insert one on the largest valves St Judes makes -- 35mm.

Did you have pain at the incision site and for how long?
I took an occasional percocet for about the first week, then an occasional Tylenol for another week.

Where did they connect heart/lung machine? Same incision or different incision near groin?
I had a groin incision for the machine, but it never gave me any trouble or pain.

Any complications at all?
They had to go in again the next day to stop a bleeder, but they used the same incision site.

How long before you were up and walking?
They had me up the next day to walk a few steps. More in the days after that.

Full recovery time?
Some afib kept me back a little, but I was back at work after 8 weeks.

Do you feel that you got a good repair? Specifically, is it holding? Do you have any regurgitation after your repair?
My original valve was too far gone to repair. So far the new valve is ticking along beautifully with no leaks.

Do you feel your surgeon could've given you a better result by doing surgery the traditional way?
I am so happy that my surgery was minimally invasive. It's not appropriate for everyone, however. And you have to make sure that the surgeon is experienced in this technique. But if that's an option for you, go for it!
 
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Bill Hall

Guest
Cooper - I had minimal invasive surgery at CCF. Very little pain, no morphine after they initial dose. I had both mitral valve repair and aortic replacement with homograft. He tried to repair the aortic and ended up being on the heart lung for over 4 hours. They had difficulty restarting my heart, had to shock it back to life. I had afib for about a month after surgery. Since I had surgery on Friday, they didn't let me walk until Tuesday, but I was standing after the first hour after I woke up. I was back to work after 6 weeks. I think I got a good repair and would recommend the minimal invasive, as long as the surgeon uses it often.
Bill
 
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Barry

Guest
I've got a St. Jude's mechanical mitral valve, installed a couple of years ago via the good old "split 'em open like a chicken" technique with staples down the middle of my chest and two weird holes in my chest where I presume tubes had been inserted for the machinery. Post-op pain was tolerable, and I'm a complete wimp. I was up and walking the hospital corridors the next day, think I was in the hospital a couple of weeks and back to work about 6 weeks post-op.
 

bvdr

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I had my mitral valve replaced with a St.Jude's mechanical via a heartport access.

Pain at incision? Yes, and quite a bit of swelling initially. I had some problems with a rib that had to be rewired into place. (Sometimes they have to temporarily remove a section of a rib to allow better access.) I was given plenty of pain pills though on discharge and I did not ever need a refill. I did have muscle spasms in my rib cage and that was really more of a problem than the incisional pain.

Complications? I did incur some damage to my right lung. I also had a small pleural effusion shortly after I was home but nothing for which I had to be re-hospitalized. I was on the bypass pump for a long time and sometimes I feel that has made me a little less sharp mentally.

Up and around? The morning after surgery the staff in CCU tilted my bed so I could be upright. That evening I believe I actually got up and then walked the following morning.

Full recovery time? Hard to say. I was traveling within several weeks but it was actually months before I felt strong again. I think I recovered fully from the surgery but the underlying heart problems are such that a full recovery is not really a reasonable expectation for me.

Do I feel I would have gotten a better result in a more traditional approach?
I don't know. I think I got a good result but I also had a surgeon very experienced in this method. I sure wouldn't allow a less experienced surgeon do it.

In some European countries (Belgium for one) most mitral surgeries are done via the less invasive methods. I think the technique is improving all the time. I think it is amazing that we even have these choices. We sure are blessed.
 
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Cooper

Guest
Thank you!

Thank you!

Thank you everyone for your insightful replies.

This is such a big decision for my husband. It's scary to think about open heart surgery. We recently watched a video of a minimally invasive mitral valve surgery. At the end of the surgery they showed the patient's heart being restarted by the paddles. My husband had not really thought about the heart/lung machine or this part of the procedure until then. I think he's really worried and concerned about this. I feel so bad for him....

Thank you again,

Cooper
 

SHerrin Hutt

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Jeffersonville. In
I hav ehad to OHS and both of them were done with opening the chest and the Heart & lung machine. Didn't have any problems other than a fever that keep me at Cleveland clinic for and extra couple of days. I was out of bed and walking with both OHS with in less than 24 hrs.
 
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SacredHeart

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World's best Valve surgeon?

World's best Valve surgeon?

Who is considered to be the world's *best* Minimally Invasive heart valve surgeon?

Has anyone heard of Didier F. Loulmet M.D, cheif Minimally invasive robotic cardiac surgery program, Lenox Hill Hospital? (Belgium Doctor working in New York.)

I am one day likely to face aortic valve surgery and I would be exceedingly grateful for any information. Thank you!

I will eventually pluck up the courage to write a little more about me, I've been lurking on this forum for a while but reluctant to post anything, I'm very nervous! :(
 
C

Cooper

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Surgeons

Surgeons

Hi SacredHeart,

My husband is about to have mitral valve repair. After seeing a number of surgeons and investigating minimally invasive here is what we've learned:

Cleveland Clinic and NYU are the two biggest centers for minimally invasive valve repair/replacement. Many aspects of minimally invasive were either pioneered or refined at CC and NYU. They do the most of any facilities and their surgeons have the most experience. NYU no longer uses the robotic arm because they found it more difficult to repair complex valves. They refined the procedure and made longer instruments and a viewing scope so that they can use their hands. NYU also refined the procedure so that they no longer have to make an incision in the groin for the heart/lung machine. Now, everything is done through one incision. Also, the surgeons at NYU helped develop a new semi-circle annuloplasty band that, in their research, is showing to be better long-term than other bands. So far, NYU's five year research shows minimally invasive to be just as good (if not better in terms of recovery) than traditional OHS.

As far as the *best* surgeons for minimally invasive, the two you hear the most about are Dr. Delos Cosgrove @ Cleveland Clinic and Dr. Stephen Colvin @ NYU. However, there are other good surgeons at CC and NYU who also do minimally invasive valve repair. We recently met with one surgeon at NYU, which is how I know a lot of this information. If you wish to speak privately, feel free to PM me.

Best,

Cooper


SacredHeart said:
Who is considered to be the world's *best* Minimally Invasive heart valve surgeon?

Has anyone heard of Didier F. Loulmet M.D, cheif Minimally invasive robotic cardiac surgery program, Lenox Hill Hospital? (Belgium Doctor working in New York.)

I am one day likely to face aortic valve surgery and I would be exceedingly grateful for any information. Thank you!

I will eventually pluck up the courage to write a little more about me, I've been lurking on this forum for a while but reluctant to post anything, I'm very nervous! :(
 

Nancy

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Joined
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Messages
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Cooper-

I wanted to address your husband's concerns about the heart/lung machine. It is a miracle machine and allows all of this kind of surgery. In the olden days, in this country, they used to put patients on an ice bed to lower the body temp. and make the heart beat slower. I do believe that we have a few members who had this done when they were young, and they do not have happy memories of the freezing temp.

It's even done in some other countries this way.

So we've come a long way from the early times, and the heart/lung machine has been front and center of heart valve surgery.

Your husband will never be aware of this part of the surgery, he'll be totally "under".

The entire surgical team is so used to the surgery and they are all expert at what they do. It is even a speciality within the field of anesthesiology.

Joe's been through three of these surgeries and he's got a lot of other medical problems. He still came through them just about like everyone else does.
 

bvdr

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WELCOME! I don't know who is the "BEST" but I know Dr. Glower at Duke is considered be among the best.

I haven't heard of the doctor you mention but I know Belgium has always been in the forefront in minimally invasive heart surgery.

Try not to be nervous about posting. We love having new members and we do have a good time while supporting one another as well.
 
C

Cooper

Guest
Nancy,

Thank you for your encouraging words. As the days go by my husband seems much more at ease about having surgery. Really, it's a good thing that we're addressing this now before he develops symptoms or chronic problems. I am thankful for how far we've come and know in my heart that he will be fine. As of tonight, I think he's decided to go with the minimally invasive procedure. We'll see how the weekend plays out. I'll keep everyone posted.

Hugs,

Cooper


Nancy said:
Cooper-

I wanted to address your husband's concerns about the heart/lung machine. It is a miracle machine and allows all of this kind of surgery. In the olden days, in this country, they used to put patients on an ice bed to lower the body temp. and make the heart beat slower. I do believe that we have a few members who had this done when they were young, and they do not have happy memories of the freezing temp.

It's even done in some other countries this way.

So we've come a long way from the early times, and the heart/lung machine has been front and center of heart valve surgery.

Your husband will never be aware of this part of the surgery, he'll be totally "under".

The entire surgical team is so used to the surgery and they are all expert at what they do. It is even a speciality within the field of anesthesiology.

Joe's been through three of these surgeries and he's got a lot of other medical problems. He still came through them just about like everyone else does.
 

SHerrin Hutt

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Messages
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Location
Jeffersonville. In
Dr. Cosgrove did my repair at CC but I had the complete OHS. But I did great! But I don't think he is during surgery now because he is the head of the CC.
 
C

Cooper

Guest
Sherrin

Sherrin

Sherrin,

I see from your signature that you had a mitral valve repair in 1999 and a replacement in 2002. If you don't mind me asking, why did you need a replacement so soon?

Reason I'm asking - I'm hoping my husband's surgeon will only do a repair on him with the intention of it lasting a long time (at least ten years). We were told by one surgeon that a lot of repairs are being done that should've been replacements to begin with. This has stuck with me. I do realize there is no guarantee. Just curious what happened in your case.

Thank you,

Cooper

SHerrin Hutt said:
Dr. Cosgrove did my repair at CC but I had the complete OHS. But I did great! But I don't think he is during surgery now because he is the head of the CC.
 

SHerrin Hutt

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Joined
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Messages
644
Location
Jeffersonville. In
They told me at the time it could last up to 10 yrs. but that was not my case. I started having trouble amost right away but in Jan 02 I had a stroke and when they did TEE they knew it was the valve. If they had replacement the valve instead of repair I probably would not be here right now. My heart was given that time to get in a better shape. I went through cardic Rehab with oxygen because I was still not getting enough oxygen to my heart but since the replacement I have not been on oxygen. I had a pacemaker put in Oct. 2004 and still the injection fraction is low for was down to 15% now 30% but getting better with each echo. I always seem to do thing s twice. I had to valve surgeries and the first pacemaker didn't work right so they had to do it a gain. But all in all I feel great to be alive!
 

Marty

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McLean, VA
Repair or replace? Minimal?

Repair or replace? Minimal?

My surgeon said he could have repaired my beat up mitral valve but I would be back on his table in two years if he did. He's been repairing and replacing mitrals for close to 20 years. You can't beat experience in this area. I had almost no pain from the sternum split and it healed well. I had a young friend who had a repair about the same time in my hospital but he had a complicated post op. It took months to get his sternum incision closed with the help of plastic surgery. If your surgeon is comfortable and experienced with minimal invasive, its probably the best way to go.
 
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