Minimally invasive vs. full sternotomy surgical approaches

[JenniferO]

I am posting several messages to the forums today on various issues.

One I would like to hear responses to is the question of minimally invasive methods i.e. right thoracotomy (sometimes known as the Heartport method) or partial sternotomy (either upper or lower). I have had countless conversations with surgeons and/or staff who are either great supporters or great opponents of these methods. The right thoracotomy seems to be the most controversial. The upper partial sternotomy method is what is used by Dr. Cosgrove. The lower partial sternotomy is used by another excellent cardiac surgeon, Dr. Lawrence Cohn of Boston. Most of the major teaching hospitals in the country seem to have adopted something less invasive than the full median sternotomy which has been the traditional approach for the last 30 years.

The opponents of the minimally invasive methods always give the reason "access" as the problem. However, the excellent surgeons who have persevered to become comfortable with the minimally invasive methods say they have absolutely all the access they need.

I was considering NYU and the mini thoracotomy method used very successfully by Dr. Stephen Colvin there for my mitral valve repair. I have now had so many warnings against it, I am hesitant to proceed in that direction.


While the marketing is that the mini-methods reduce time in the ICU, the hospital, and recovery time. there is quite a lot of literature that suggests that is not the case and that pain and recovery time is just as great as with the full sternotomy. There is even literature that suggests that the right thoracotomy is more painful than any of the sternotomy methods.

As a female, anything that results in a shorter incision than the full sternotomy seems desirable to me, though repair of my mitral valve is surely paramount.

I am just wondering who on these boards has had experience with the mini-methods.

 

[Nancy]

Hello Jennifer, Welcome

Hello Jennifer, Welcome

Hi Jennifer-

Welcome to this site. It's a wonderful teaching tool, hand-holder and has a group of the warmest, most compassionate friends that can help you through this because they've all been there.

My husband is the patient here and I do all his computer things for him because he "hates" the computer, and I love it.

He had rheumatic fever as a teen (he's 70 now). He had an aortic valve replacement in 1977 with a Bjork-Shiley mechanical (full sternotomy), a mitral valve replacement with a St. Jude mechanical in 1999 (full sternotomy), and a mitral valve repair this year July 18 (heartport-thoracotomy). In addition to those operations, he has had two thoracotomies, one for a benign tumor on one side and one for scar tissue that had partially collapsed his lung, on the other side, and has a pacemaker.

I know that he feels that the pain post-op after thoracotomies is more severe than what he experienced with the sternotomies. But the recovery was faster with the heartport surgery. And it didn't take as much out of him as did the sternotomies. Unfortunately he did suffer a very severe allergic reaction (serum sickness) to an antibiotic (which he had never been allergic to before) after his last surgery that put him back in the hospital, but I know that his recovery would have been relatively smooth sailing if that hadn't happened.

The pain associated with the thoracotomies has lingered on for a very long time. There must be a lot of nerve tissue that has to grow back after cutting through the back, side and chest-lung area. There are also very large muscles which have to grow back together and every movement is painful.

The surgeon did not feel hampered at all with the heartport opening and found that it gave good access to viewing the mitral valve location.

In order to do heartport, you must have blood vessels in good shape, because they have to cannulate up to the heart from the groin area. Joe has a very long scar in that area.

One other thing is that even though you and the surgeon have made the determination for such and such a valve, it can all be changed "on the table" when they open you up, as many here have found. It is just not possible to view all the problems within the heart from all of the various tests that will be done. And your surgeon will be the final decision maker. But I think they will do their very best to honor your wishes if at all possible.

Joe's has been on Coumadin for 24 years with no problems of any consequence. He gets tested at 2-4 week intervals and makes the dosage adjustments that the doctor gives him. Don't let Coumadin scare you into getting a valve you wouldn't have considered otherwise. It's really no biggie. The mechanicals are excellent valves. Having multiple open heart surgeries in one's lifetime gets harder and harder as the years go by and they all take their toll.

Best wishes with your research, and we hope to see you often.

 

[Kevin M]

Well said, Nancy. I don't know that there are a ton of people who have have minimally invasive surgery here. You don't hear much about it.

I know when I was exploring options, my surgeon was opposed to it and thought I was a bit silly given it was my second surgery. I heard the recovery time might be shortened and that's why I was interested. The scar thing didn't bother me since I've already got the zipper from the first procedure.

A a business associate of mine has a 17 year old son who had MV repair through heartport and he was golfing a little more than a week later. I guess that's a testament to youth more than anything else.

I didn't realize there would be a lot of pain with the heartport. I suppose I always thought cracking the sternum would be more painful. It makes sense when you think about it. I know I never really felt a lot of pain in the sternum and chest. Just a numbness mostly. Bones don't have nerves and there doesn't seem to be a lot of tender nerve endings in the central chest area either.

I'd be interested to see what ticktock has to say about this with her experiences.
Kev

I think the

 

[sylviayasgur]

hi jennifer!
welcome. you have come to a wonderful place. everyone here is so supportive and kind and helpful. it really made a difference to have this while my husband joey was going through his surgery (and as he still recovers).
although i can't be of much help to you, i thought you might want to check out a new thread in post surgery entitled surgery done. brad just had his mitral valve repaired and had it done by dr. cosgrove at cc.
hope this helps. i'm sure there will be many here who can give you more info regarding your case.
in the meantime be well, God bless and please let us know what's going on.
-sylvia

 

[Bill Hall]

Hi Jennifer - Welcome to the site. I had my surgery done by Dr Cosgrove and am happy with the results. A three inch scar on my chest and I hardly ever notice it.