Open heart surgery and redo operations

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Chuck C

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They left the wires in? I didnt think that was a thing they would do. As long as it doesnt cause issues i guess.. or taking them out of bone could be more risky.

I did see your post about your sternum issue. Looked very swollen and pus filled.
Ill have a look for the other post -
surgical complications"

only sternal wires are used in Australia, why?
Have you ever had a sternal wire break?
I have my bottom sternal wire break 2 years ago. It felt like a broken rib and swelled up badly but nothing came of it.
I now use it as a quiz for the students who do imaging scans to see of they can see the broken wire.
I don't believe it is just an Australia thing, in terms of using wires to hold the sternum together. I am almost certain that wires were used on my sternum as well in the US. Wires for the bones and then glue for the soft tissue- no stitches or staples. He likes this method because it leaves very little scar. Right now, at 7 weeks out, I have no palpable scar just a 3 1/2 inch red line on my chest without the slightest bump. Not what I expected. It is looking like it will not be noticeable at some point. I'm a bit disappointed, as I was hoping to be able to compare battle scars in my old age and now no one is likely to believe me 🤣
 

pellicle

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Also, in the "double image", it sure seems to have the same twists and follow the same path around the bone as the other wire.
hopefully this clarifies things, I recommend you view it at magnification (on a desktop there is a little magnifying glass after you click the image, on a phone you just pinch and zoom

New wires labled as "wires"
Yellow ellipse highlights "some" staples

1620967036458.png


as I had the top two out in 1993 (after my 1992 surgery) I'm inclined to believe these are remanants from the 1992 surgery.


HTH
 

Chuck C

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hey, there's a thing called "Talons" if I recall correctly. I don't think they've passed approval here yet
Yeah, those look pretty slick from the demo video that someone recently posted. Do you know if they are designed to be removed or left in?
 

MdaPA

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hopefully this clarifies things, I recommend you view it at magnification (on a desktop there is a little magnifying glass after you click the image, on a phone you just pinch and zoom

New wires labled as "wires"
Yellow ellipse highlights "some" staples
Yes, your image with the arrows clarifies things. There's plenty of hardware in there!
 

MdaPA

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Do you know if they are designed to be removed or left in?
From the below video, it looks like Sternal Talon's can be removed. Guessing they have to be removed for a re-operation if the bone has completely healed?


Here is a video of them being installed:

 
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pellicle

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Guessing they have to be removed for a re-operation if the bone has completely healed?
It's normal that the bone is completely healed. The wires are only for the bone knitting period.

As to hardware, this is my friends arm; shoulder, elbow and wrist. Feel of his scooter

 
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Meanjellybean

Aortic Mechanical valve - Carbomedics 23mm
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Really enjoy the talk and community here. My Opening post seems to have been sidetracked a little.

Re-asking:

I was hoping to get your experience with OHS and specifically the difference if you have required to have a reoperation?

Any and all input appreciated 🙂👍
 

pellicle

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I was hoping to get your experience with OHS and specifically the difference if you have required to have a reoperation?
I thought I offered input?

probably not helpful, because surgery was 10yo, however 2 redos. Last Redo was at 42 and it went "unremarkably" from the terms of healing
however I don't think I replied to this:

Thats awesome to hear it was unremarkable. I gather the longer apart the surgeries the better.
I have no way to know, but I don't see the differences between old scar tissue and new. Perhaps the bone healing may vary (and yes that gets scar tissue too), but I can no longer find that source.


Myself I didn't experience significant differences in pain or recovery (apart from the obvious one).

With respect to "longer surgeries" I believe that this is the principle cause of my propioni infection



 
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Meanjellybean

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I thought I offered input?



however I don't think I replied to this:



I have no way to know, but I don't see the differences between old scar tissue and new. Perhaps the bone healing may vary (and yes that gets scar tissue too), but I can no longer find that source.


Myself I didn't experience significant differences in pain or recovery (apart from the obvious one).

With respect to "longer surgeries" I believe that this is the principle cause of my propioni infection



Hey @pellicle ,
Yes you did answer and I thank you for your input. And as always you go above and beyond for members by providing well sourced articles and links for us to review.
I was just opening up for others experience 🙂

I mainly reask as this is more of a subjective experince that objective.
Its like those who may have had endocarditis and require a redo will have a vast difference in comparison to one who requires a new tissue valve..

I gather from the amount of tissue valves that surgeons conduct that redo is not a big issue for surgeons. Otherwise redos would be avoided at a higher rate..
 

Meanjellybean

Aortic Mechanical valve - Carbomedics 23mm
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Hey @pellicle ,
Yes you did answer and I thank you for your input. And as always you go above and beyond for members by providing well sourced articles and links for us to review.
I was just opening up for others experience 🙂

I mainly reask as this is more of a subjective experince that objective.
Its like those who may have had endocarditis and require a redo will have a vast difference in comparison to one who requires a new tissue valve..

I gather from the amount of tissue valves that surgeons conduct that redo is not a big issue for surgeons. Otherwise redos would be avoided at a higher rate..
Also @Chuck C. Appreciate your input. Your a legend! 🙂👍
 

MdaPA

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I was hoping to get your experience with OHS and specifically the difference if you have required to have a reoperation?
My darling wife has had 3 OHS's for valve repair and replacement:

1) 1997: ROSS procedure with MV commissurotomy (repair).
2) 2000: MVR with pericardial bovine valve (as the MV repair in 1st surgery failed).
3) 2017: AVR and MVR with St. Jude (Master series) valves, PVR with porcine valve, and repair of TV.

Her hospital stay and recovery time got shorter and shorter with less complication(s) after each OHS. This most likely is attributable to medical and technical advances in anesthesia, pain meds, and the like to reduce complications and improve recovery.

In her 3rd OHS, even though she had all 4 valves worked on (3 replaced and 1 repair), if it wasn't for her INR not being in range yet, they would have discharged her in just 2 full days after her 8 hour surgery. Amazing!
 

MdaPA

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I gather from the amount of tissue valves that surgeons conduct that redo is not a big issue for surgeons. Otherwise redos would be avoided at a higher rate..
Re-operations, and not just for open heart, are complex and demanding on surgeons. There can be dense scar tissue from prior surgery(ies) that needs to be painstakingly and precisely peeled off/removed so as to not injure nerves, tissue and organs. You should seek out a surgeon who has experience and skill with redo's.
 

Meanjellybean

Aortic Mechanical valve - Carbomedics 23mm
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Re-operations, and not just for open heart, are complex and demanding on surgeons. There can be dense scar tissue from prior surgery(ies) that needs to be painstakingly and precisely peeled off/removed so as to not injure nerves, tissue and organs. You should seek out a surgeon who has experience and skill with redo's.
What an amazing journey and recovery times your wife had. Better with each OHS. Who would of thought.. experience and medical advances really do help over time.

Yes i agree with having experience when a redo is required.

That is why i am awaiting on my surgeon who is the senior in the hospital with over 40 years experience.. problem is that everyone wants him so the wait sucks.
 

tezza

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Really enjoy the talk and community here. My Opening post seems to have been sidetracked a little.

Re-asking:

I was hoping to get your experience with OHS and specifically the difference if you have required to have a reoperation?

Any and all input appreciated 🙂👍
Hi Meanjellybean,
I had a redo done end of March this year. My first surgery was 12 years ago. Not sure I can give you much comfort, as my two surgeries went differently, although the same type of valve was put in (tissue value due to blood issues). First surgery, I had a haemorrhage after surgery that needed me to go back in again so they could reopen and stop the bleeding. That didn't happen this time, but I had masses of issues post- surgery to do with the blood again, heaps of platelets and blood transfusions. I do know that to get the same size valve in I had to have a patch put on the aorta to enlarge it, due to scar tissue, so scar tissue is an issue as some have already said. I've yet to see my surgeon for post-surgery check, so I will quiz him more about what he found then.

Second time around, I knew more of what to expect and that actually helped enormously, although things were somewhat different due to the complications, but generally speaking, there were a lot of things that I knew about so overall, fewer surprises. Once out of hospital, which was a longer stay this time, my recovery at home has not been too different to first time round (apart from a shoulder issue which is new). I went into the surgery in as best shape I could be, as I did first time around, and I think that helps a lot. I do think that perhaps my energy levels have taken a bit longer to come back but I am 12 years older, so that might just be a function of that and not so much the second surgery, I don't know. I think I was probably as fit, and maybe a bit fitter before this surgery than the first.

One thing I do think though, is that the sternum is taking longer to heal this time than the first time. I feel that I have plateaued and over the past two weeks, not really seen any improvement, but that may also be related to the issues I'm having with my shoulder. So will be good to have that checked by the surgeon this week when I see him. I am almost 8 weeks post surgery, and my memory of last recovery is a little sketchy, but I'm pretty sure I was back to most day to day things by this time. But I'm having to be more careful about lifting stuff, driving is not painfree, and I'm noticing specific painful areas during some activities.

My scar has healed beautifully, and in actual fact, is a much nicer zipper than my first one - maybe my surgeon got better at that, lol! So I'm happy that it is a much finer scar. However, this time round, I have some areas of numbness over one side of my chest, and also some hypersensitivity, which I don't recall last time. It is gradually decreasing, so I'm hopeful that over the next 6 months, it should disappear altogether as the nerves innervate, but time will tell.

Speaking of scars, this time round, I had four drain tubes, but only 2 first time, and the drains weren't put in the same place, which surprised me, I had somehow assumed he would just use the same spot. But I guess scar tissue is probably the issue there, so I now have 6 drain scars now! Someone said I should get a tattoo of noughts and crosses on my stomach, because of where they are positioned, lol!

Something that struck me also this time round was that once I was through the first few days, and the PCP was gone, they were reluctant to give any pain meds stronger than panadol. Last time round, sleepers were also given at night, but this time, they were not on the menu. I guess the way things are done change over time.

If there is anything specific you would like me to answer, please let me know. Sorry, I have rambled on, once you get me started, I'm hard to stop! Hope that helps in some way.
 

slipkid

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Schwenksville, PA, USA
Hi Meanjellybean,
I had a redo done end of March this year. My first surgery was 12 years ago. Not sure I can give you much comfort, as my two surgeries went differently, although the same type of valve was put in (tissue value due to blood issues). First surgery, I had a haemorrhage after surgery that needed me to go back in again so they could reopen and stop the bleeding. That didn't happen this time, but I had masses of issues post- surgery to do with the blood again, heaps of platelets and blood transfusions. I do know that to get the same size valve in I had to have a patch put on the aorta to enlarge it, due to scar tissue, so scar tissue is an issue as some have already said. I've yet to see my surgeon for post-surgery check, so I will quiz him more about what he found then.

Second time around, I knew more of what to expect and that actually helped enormously, although things were somewhat different due to the complications, but generally speaking, there were a lot of things that I knew about so overall, fewer surprises. Once out of hospital, which was a longer stay this time, my recovery at home has not been too different to first time round (apart from a shoulder issue which is new). I went into the surgery in as best shape I could be, as I did first time around, and I think that helps a lot. I do think that perhaps my energy levels have taken a bit longer to come back but I am 12 years older, so that might just be a function of that and not so much the second surgery, I don't know. I think I was probably as fit, and maybe a bit fitter before this surgery than the first.

One thing I do think though, is that the sternum is taking longer to heal this time than the first time. I feel that I have plateaued and over the past two weeks, not really seen any improvement, but that may also be related to the issues I'm having with my shoulder. So will be good to have that checked by the surgeon this week when I see him. I am almost 8 weeks post surgery, and my memory of last recovery is a little sketchy, but I'm pretty sure I was back to most day to day things by this time. But I'm having to be more careful about lifting stuff, driving is not painfree, and I'm noticing specific painful areas during some activities.

My scar has healed beautifully, and in actual fact, is a much nicer zipper than my first one - maybe my surgeon got better at that, lol! So I'm happy that it is a much finer scar. However, this time round, I have some areas of numbness over one side of my chest, and also some hypersensitivity, which I don't recall last time. It is gradually decreasing, so I'm hopeful that over the next 6 months, it should disappear altogether as the nerves innervate, but time will tell.

Speaking of scars, this time round, I had four drain tubes, but only 2 first time, and the drains weren't put in the same place, which surprised me, I had somehow assumed he would just use the same spot. But I guess scar tissue is probably the issue there, so I now have 6 drain scars now! Someone said I should get a tattoo of noughts and crosses on my stomach, because of where they are positioned, lol!

Something that struck me also this time round was that once I was through the first few days, and the PCP was gone, they were reluctant to give any pain meds stronger than panadol. Last time round, sleepers were also given at night, but this time, they were not on the menu. I guess the way things are done change over time.

If there is anything specific you would like me to answer, please let me know. Sorry, I have rambled on, once you get me started, I'm hard to stop! Hope that helps in some way.

Wow, 4 drain tubes. Ouch! I had 3 for my surgery. Funny story about how the physician's assistant took them out but no time for that now. If I have my shirt off and anyone asks what those weird scars are I say I was attacked by a guy who had a knife & a gun, the big scar is the knife he sliced me with and the hole-things are where he shot me. However I was able to disarm him with a vicious attack of sarcasm invoking dramatic irony, metaphor, bathos, puns, parody, litotes and satire. In response to my ripost he pulled his own head off so you could say I won in the end.

I too had shoulder damage/injury from my surgery. Did not realize it with everything else going on needing to heal first. Eventually as other things calmed down I realized there was something majorly wrong with my shoulder. Could not lift my arm comfortably and could not offer any resistance if extending arms up at sides like wings and have anything pressing on my hands. It was diagnosed as impingement of the supraspinatus muscle. I had to go to physical therapy for that and do home exercises/techniques for about 2 months then was good as new. I assume that during my surgery they moved me around in various uncomfortable ways and screwed that muscle/joint up.

Good luck to you in your recovery!
 

Paleowoman

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I too had shoulder damage/injury from my surgery. Did not realize it with everything else going on needing to heal first. Eventually as other things calmed down I realized there was something majorly wrong with my shoulder. Could not lift my arm comfortably and could not offer any resistance if extending arms up at sides like wings and have anything pressing on my hands. It was diagnosed as impingement of the supraspinatus muscle.
I had problems with my left shoulder which were caused by the surgery, diagnosed incorrectly at first as partially torn tendon and impingement syndrome and made worse by the physiotherapy I was given for that. Eventually, five years after surgery, due to pain in my sternum, an MRI of it revealed that my left sternoclavicular joint had been damaged, there was/is an effusion and degenerative changes with it as a result of surgery - all that manipulation, and this led to referred shoulder pain. I now am just not able to do the kind of weight lifting I did prior to surgery because it leads to such bad left shoulder pain.
 
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