Post Op Less Invasive Mitral Valve Repair

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dwc

Member
Joined
May 14, 2012
Messages
6
Location
Central florida
I'm heading for MV repair and would appreciate post op feedback from anyone who has had the Less Invasive surgery. Pain, time off work, range of movement, and any home prep before surgery are some of the areas I'm wondering about.

DWC
 
Yes, are you having a smaller sternotomy or a thoracotomy?

I had a thoracotomy for an AVR; the incision was about 3 inches. I would say my pain was minimal at most. I could drive 2 weeks post-surgery and did not have the back and neck aches that many have post surgery, also had no trouble getting in or out of bed and no need to sleep in a recliner.
 
Welcome to Vr.org. Happy you found us.

Some surgeons will agree to doing right thoractomy for mitral repair but usually feel they have better access and 'more room to work' for best chance of successful repair if they do sternotomy.... even a mini sternotomy.
This is definitely something to discuss with your surgeon.
Good luck at your consultation.
 
I had a mini-stern two years ago, and was out of work for four weeks. The healing sternum took the typical amount of time as any other broken bone -- about six weeks. However, sneezes were bad for a bit longer, and that pain was more in my diaphragm, since there were some pacing lines and drainage tubes in that area. The worst pain was probably in my shoulder, which I was surprised about until the ICU nurse explained that was a common side effect of the way they contort your body on the operating table. The home prep I would most recommend would be to practice standing up and sitting down without pushing with your arms, since that's something that will be prohibited if you have any sort of sternotomy.
 
My surgeon gave me the option. I went with the sternotomy because I had heard it was less painful since they wouldn't be cutting through muscle. From my experience and others that I've talked to, it seems like with the sternotomy you have longer term aches and pains, but didn't have the more intense pain that some people report with a thoracotomy.

Range of movement...honestly don't really remember much abou this, so must have been pretty good.

In terms of pain...I would say you will recover more quickly if you get up and get moving. If you allow everything to get and stay all tightened up, you will feel more pain for longer. I won't say there was no pain, but one my tubes were all out, I prett much used only OTC meds.

Work....surgeon cleared me after 5 weeks. Physically, I'm sure I could have handled it, but mentally, I was not ready. I was out of work for 2 full months. I didn't have memory issues or anything, but I didn't feel like I could focus at all. That eventually went away too ~7-8 weeks.

Preparations at home...if you have a recliner or access to a recliner, you might want it. I found that I wanted to adjust my position frequently and it was easier to do in a recliner than the couch. Also great for napping. If you have access to a treadmill or other cardio exercise equipment, get it set up. I liked to walk outside best, but I didn't want an excuse not to walk in bad weather (hot, cold, rainy). Also my initial walks were so short it didn't even make sense to go outside. Last but not least, I was dizzy from the diuretic, and didn't want to go too far from home and end up passing out or something.
 
Luana said:
Yes, are you having a smaller sternotomy or a thoracotomy?

I had a thoracotomy for an AVR; the incision was about 3 inches. I would say my pain was minimal at most. I could drive 2 weeks post-surgery and did not have the back and neck aches that many have post surgery, also had no trouble getting in or out of bed and no need to sleep in a recliner.
Click to expand...

Best advice I can give, go buy a lazy boy recliner; even if you donate it after you recover, it is worth every peney. This will be your home hospital bed for the first month. It also keeps your lower back from hurting, as you can not sleep on either side. Don't buy the sheik one, get the big fluffy grandpaw version. Sleep on a couple layers of towels because you will sweat like a wh--- in church for the first month. As you wake up wet peel a towel layer away.

I had this exact surgery, and the recovery from the access area was nothing.
 
Both surgeons I spoke with said that there was little need for a sternotomy in my case. Both claimed they would have a high probabilty of repair with minimal invasive. Both said that it's always better to avoid cracking the sternum if it wasn't necessary.
 
This is the 4th week anniversary of my right side thoracotomy and for the most part feeling great. I walked out of the ICU into a regular room after about 12 hours after surgery was finished.... It ended up being a 7-1/2 hour procedure to repair my mitral valve. It was successful. Yes it is less invasive, but you will have several incisions on your right side under your nipple extending to your arm...for me I have one 4"+ incision a 1" incision and 5 smaller incisions surrounding the larger one. No ribs were broken...just spread apart. You can go to my blog at http://simongphoto.blogspot.com to see the before/after photos as well as the valve repair. I was wheeled into the operating room about 12:30pm or so and then kept asleep until around 3am when they removed my breathing tube. I don't really remember much until 5 or 6am when they had me sitting up. I was feeling good enough to walk from the ICU to my regular room.
You will also probably have two incisions in your groin and actually that was the worst pain while I was in the hospital... blue balls... numbness on my left leg that was painful when I walked the halls. The pain here took my mind away from my one drainage tube which wasn't removed until the day I left the hospital. Surgery on Monday afternoon.... left to go home Saturday. I was walking a lot around the hospital...getting in at least 2 miles a day by the time I left. I'm now averaging 2-4 miles every day briskly walking depending on my time. I'm back to work some this week after a relaxing weekend at the beach. I've been driving for 2 weeks although the seatbelt against my right side kept me pulling the belt away from my chest with my other hand. I drove to the beach this week and used a pillow. It still feels numb and I would compare it to sun burn now...that won't go away. Clothing just seems to nag at the skin and is bothersome...but completely manageable. The groin pain went away after week 2.
Note: The drugs they give you in the hospital will likely make you very constipated. Do what you can to reduce that. Drink plenty...lots of fiber. I didn't manage that well and am still having some issues with hemmoroids and constipation caused by the arythmol they will probably put you on as well. Hope this helps. Good luck.

Mitral Valve Repair- Duke University 5/14/2012 using a 35mm annuloplasty band. Kind of ironic since I'm a photographer.
 
Scg, your incision is bigger than mine, and I just had the one cut in the chest, but, of course, yours was a different valve. Groin incisions are what connect you to the heart lung machine. I didn't find mine painful. Probably the most annoying pain was from the chest tube. That seemed to be more sore than anything for the longest, and though I could have slept on my right side at about 2 weeks, soreness from the chest tube put that off another week or so.
 
scg said:
This is the 4th week anniversary of my right side thoracotomy and for the most part feeling great. I walked out of the ICU into a regular room after about 12 hours after surgery was finished.... It ended up being a 7-1/2 hour procedure to repair my mitral valve. It was successful. Yes it is less invasive, but you will have several incisions on your right side under your nipple extending to your arm...for me I have one 4"+ incision a 1" incision and 5 smaller incisions surrounding the larger one. No ribs were broken...just spread apart. You can go to my blog at http://simongphoto.blogspot.com to see the before/after photos as well as the valve repair. I was wheeled into the operating room about 12:30pm or so and then kept asleep until around 3am when they removed my breathing tube. I don't really remember much until 5 or 6am when they had me sitting up. I was feeling good enough to walk from the ICU to my regular room.
You will also probably have two incisions in your groin and actually that was the worst pain while I was in the hospital... blue balls... numbness on my left leg that was painful when I walked the halls. The pain here took my mind away from my one drainage tube which wasn't removed until the day I left the hospital. Surgery on Monday afternoon.... left to go home Saturday. I was walking a lot around the hospital...getting in at least 2 miles a day by the time I left. I'm now averaging 2-4 miles every day briskly walking depending on my time. I'm back to work some this week after a relaxing weekend at the beach. I've been driving for 2 weeks although the seatbelt against my right side kept me pulling the belt away from my chest with my other hand. I drove to the beach this week and used a pillow. It still feels numb and I would compare it to sun burn now...that won't go away. Clothing just seems to nag at the skin and is bothersome...but completely manageable. The groin pain went away after week 2.
Note: The drugs they give you in the hospital will likely make you very constipated. Do what you can to reduce that. Drink plenty...lots of fiber. I didn't manage that well and am still having some issues with hemmoroids and constipation caused by the arythmol they will probably put you on as well. Hope this helps. Good luck.

Mitral Valve Repair- Duke University 5/14/2012 using a 35mm annuloplasty band. Kind of ironic since I'm a photographer.
Click to expand...



I had full sternotomy and same as you was walking about 12 hours post op. I walked a short bit in ICU, then walked to a wheelchair where I sat and ate half a sandwich and cup of coffee. They then wheeled me to step down where I walked with nurse (and DH) in the hall while still having four drainage tubes in me. They put the containers on a wheelchair and I held the handles and pushed the whole lot while I walked.

My surgery was Thursday and I came home Tuesday.

I think given the pain you suffered in your groin, side and the assortment of incisions, given the option, I again would request the sternotomy. That was my second OHS and my cardio permitted me to drive for short hops, quick light errands at under three weeks. I was walking two miles daily by then and only taking tylenol during the day.
 
I'm still glad of the less invasive approach. I think the groin pain would have been the same regardless. The scars are minimal now almost 5 weeks and I have no problem walking 4 miles a day...starting to jog some today. The question I'll never get to know is would the surgery have been shorter had they done the sternotomy. My surgery was over 7 hours...potentially because of the limited access? the degree of difficulty in fixing the valve? the fact that they fixed the valve where other surgeons might have had to replace it? These are all questions that I'll probably never get answers to, nor does it matter as long as the valve was repaired well. I guess I won't know that for sure for months or even a year until I can assess my ability to return to the activities that I was doing prior to surgery...ie biking 30-100 miles on a Saturday.
 
Glad you're felling better scg. The repair part of my surgery was less than an hour iirc. The setting up part and all prep made the entire procedure 3-4 hours. I would be inclined to ask the surgeon how he thought it went. There's alot of different things going on and he most likely has a good reason. Goes to show how every procedure can have different outcomes based on many factors.
 
DWC - You don't say if you are male or female. If you are a woman there can be concerns with undergarments, specifically bras, after a thorocotomy. Men shouldn't have that concern ;-P Seriously, though, there's nothing "minimal" about any OHS. I'm happy with my right thorocotomy. My scar is just about invisible. Recovery was OK, the pain was intense at first but not bad in the long haul. I worked on getting strength back in my right arm in cardiac rehab as I had some weakness due to cutting the chest muscle. All in all it was a good choice for my mitral repair.

I wish you all the best in your surgery and recovery.
 
DWC, I had a similar experience to ejc61 (above). The benefit of the robotic approach, and presumably other less invasive approaches, is the idea that you can get discharged from the hospital faster which reduces the risk of infection. Pain will vary (although without cutting the sternum you should definitely have less pain), but the risk of infection I believe is the most troubling. Interestingly, I had a quick recovery from the hospital and actual surgery, but 10 days later found myself in terrible pain from inflamation of the pericardium around the heart. I forget the term but it occurs in maybe 10% of OHS patients (regardless of how invasive the surgery was). It's just a delayed physical reaction to the cutting of the pericardium. So that landed me back in the hospital on big doses of Naproxen. It took a weekend to recover from that and I'd say that was the worst part of the recovery. Just bad luck, but nothing terrible.
 
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