RIB Spreading Entry Experiences

[ALCapshaw2]

Calling all Alternative Entry Patients -

History: At the time of my Aortic Valve Replacement with a St. Jude Mechanical Valve, my Mitral Valve was known to be diseased but still functioning moderately well. Since then it has continued to deteriorate due to Mitral Stenosis with Radiation Damage being a prime contributing factor.

Following Tests (Echocardiogram, Stress Echocardiogram, Left and Right Heart Catheterization), and increasing symptoms of SOB (Shortness Of Breath) with Exertion beyond walking on level ground, my Cardiologist and chosen Surgeon recommend Mitral Vavle Replacement. Both my Cardiologist and Surgeon are 'OK' with waiting a couple of months to allow me to 'get my ducks in a row', with instructions to CALL if my symptoms worsen.

My Cardiologist and Surgeon independently recommend Side Entry to avoid a third opening of my chest, minimize scar tissue issues, and to protect my Bypass Grafts. I note that other Radiation Survivors have received similar recommendations if / when the time comes for MVR so I am comfortable with that recommendation.

My QUESTIONS for anyone who has had Valve Replacement Surgery by Side Entry (i.e. by Spreading their Ribs) is:

How Painful was that procedure
during the first 2 Weeks?
during the first 2 Months?

Have you had any Long Term PAIN
from having had your ribs spread?

How well was your PAIN controlled?
By what means?

My surgeon said he will install a Pain Pump for the duration of my hospital stay and use whatever medication is necessary (and works) for discharge.

'AL Capshaw'

 

[Kathleen]

Al
I don't know if I can be much help to you but perhaps some similar surgical information can be shared. Where exactly will they begin and end the incision? How can they do rib spreading if they do a side entry. After my third heart surgery the phrenic nerve was severed which caused my diaphragm to be paralyzed. One year later we had to go in and reinflate the lung and move the organs that had shifted to their original position. We used the side entry with the incision beginning about 8 inches below my armpit and then traveling to my back and shifting upward at about my spinal cord. If that is where they will go let me know and I can share more. They had to remove a rib to gain entry. My fourth heart surgery was done under the breast with the incision being about 8 inches long. I hope I will be able to help you with some of your concers if the incisions are similar.
Kathleen

 

[Nancy]

Al-

Joe's third was through his side with the ribs spread. He had some pain, but it wasn't like the sternum surgery pain. There are several entry points and they are sore. Your lungs get banged up and are sore, there is an incision under the breast area that gets swollen and sore. The groin incision is sore. He didn't complain inordinately about rib pain, and took the normal pain meds right after and a few when he came home, but things settled down quite nicely. I seem to remember him going out shopping to the mall with me where we found our sweet little dog Harriet, maybe two weeks out. He was tired to be sure and didn't stay long, but he did it.

I would say this kind of surgery has a shorter and less painful recovery. I would say that the tiredness is about the same. His ribs were not broken or removed.

 

[ALCapshaw2]

Karlynn,

To answer your question about the incision, I was told it will run from under my right nipple around to the middle of my right side.

I'm playing 'Phone Tag' with my Surgeon's assistant and hope to hear more soon. Options are the last week of February or sometime after April 1 with NO backup play if I go downhill while he is out of the country in March (which has me concerned!)... The only way I could get an On-X valve in March would be to show up at Emory (via the ER?) in Atlanta. I don't like that plan either...

Hopefully I will know more tomorrow.

'Al Capshaw'

 

[catwoman]

Al:

Please post whatever info you get about this.

We've exploring the port-access incision for my husband's surgery. We see our cardiologist this afternoon for results of 1 regular echo, 1 stress echo & 1 TEE.
I spoke to a nurse in Dr. William Ryan's office in Dallas earlier this week about the port-access approach for mitral valve repair.

 

[Susan BAV]

Hi Al -

I don't know if what you're describing is similar to the J cut that I had with my first surgery. My incision begins under my left arm and circles around my back and curves upward and is a foot long. It was EXTREMELY painful. I couldn't even move or lift my left arm at all, not even to scratch my nose, for many days. The pain was so bad I could barely speak; and when I walked, I leaned badly. I had to do exercises where I would crawl my fingers up a wall. It was all very painful. My entire torso was one huge swollen bruise. Quite a shocking transformation for a cute little skinny teenager.

The muscle tissue never healed smoothly and is rather lumpy (like a quilt that needs the stuffing redistributed) and there is still an odd numbness around the scar and sometimes it really itches -- and it's well over 27 years old. The drain hole is like a plus sign and a few inches down my ribs on my left side.

I was not quite 18 when I had the surgery, though, and I recovered very quickly. I was driving after a couple of weeks; and, although I had to close the door with my right arm, I was driving a stick-shift then. One thing that was really odd and tenderly painful was how many people/friends would pat me on my back when they would see me, not realizing that's where the heart surgery incision was!

Comparing that pain to the sternum cut, the first surgery was worse initially but I didn't have any longterm pain; and I do still have some longterm pain with the sternum cut and my ribs.

 

[Kathleen]

Susan
That is the incision I was talking about for my lung. It has been the worse one ever and to this day there is still an odd painful numbness. I had many nerve blocks and even ablation of the nerve. It was terrifically painful to have those nerves regenerate. Mine was done 10 years ago and I doubt the pain will ever go away. There are so many nerves that have to be involved in the surgery. When they did your surgery did they remove a rib?
Kathy

 

[Susan BAV]

Susan
That is the incision I was talking about for my lung. It has been the worse one ever and to this day there is still an odd painful numbness. I had many nerve blocks and even ablation of the nerve. It was terrifically painful to have those nerves regenerate. Mine was done 10 years ago and I doubt the pain will ever go away. There are so many nerves that have to be involved in the surgery. When they did your surgery did they remove a rib?
Kathy

Hi Kathy - I'm really sorry to read that you are still having pain. I don't recall ever hearing that they had to do anything with my ribs during that surgery but I don't really know. It was to work on my aorta though, so maybe they didn't have to have as much room to work or something as they would need for a lung.

I have had doctors ask me if I've had lung surgery when they've examined me and seen that big monstrous scar across my back. And I hear you about that odd numbness. And sometimes when it's really itchy and I have my husband scratch my back, there is a creepy and icky pain in there.

Interestingly, right before that surgery I'd had an angiogram in another hospital and they put something into my left thigh with a huge needle during that hospital stay. The thigh muscle went numb then and stayed in a state of icky numbness for nearly 20 years with gradual recovery.

I hope your pain resolves. Take care.

 

[perkicar]

Calling all Alternative Entry Patients -

History: At the time of my Aortic Valve Replacement with a St. Jude Mechanical Valve, my Mitral Valve was known to be diseased but still functioning moderately well. Since then it has continued to deteriorate due to Mitral Stenosis with Radiation Damage being a prime contributing factor.

'AL Capshaw'

Al, I'm sorry you're looking at doing this AGAIN. I'm glad you've shared your experiences and asked these questions, though. I've been wondering if I should keep going to Cleveland for follow up (albeit once a year) and from what you've said, I think I shall.....Dr Griffin is more attuned to changes in the echo than my local cardiologist, and if I were to need surgery again, I would want Dr Lytle to do it. Brrrr, I'm going to try and not think about that!
Please keep us posted on your plans! In the meantime, I'll keep you in my prayers.

 

[bvdr]

Al, I had my mitral valve replaced via the heartport access not under my right breast but through the lower half. I have some lung damage that has been attributed to the abuse the right lung goes through to allow access. I haven't had my sternum opened so I can't really compare. The most painful thing to me was the muscle spasms I had in my right chest for the first week or so. Morphine took care of most of the pain though. I had a pleural effusion within the first few weeks but that can happen following any chest surgery.

I was driving much earlier and that was very nice. I know it takes longer to do the actual surgery but in your case it sure seems like the best option since of all the scar tissue. I'm thinking you won't find it too bad.

 

[ruth]

Sorry, don't know how I missed this post.....

Sorry, don't know how I missed this post.....

I just had the right thorocotomy incision. It is basically a smilyface scar that is directly UNDER my breast in the fold where nobody can see it. It is as long as the breast is wide. I also have another incision, used for the pump, right along the top of my leg in the groin fold. That incision never bothered me a bit.

My surgeon said that 2 months is the tipping point where the sternotomy folks will still have pain where the rib folks won't. Before 2 months the pain is apparently worse for the rib incision. I, of course, cannot compare.

How Painful was that procedure
during the first 2 days? - I'd rather have a baby, it really hurt
during the first 2 Weeks? - Like a major leaguer mistook my ribs for the strike zone
during the first 2 Months? - Incision pain for me left at about 5 weeks, haven't taken any pain meds since then.

Have you had any Long Term PAIN
from having had your ribs spread? - no, but I'm only 7 weeks out.

How well was your PAIN controlled?
By what means? Fentenal (sp?) drip in hospital first 2 days. Hurt like hell, I woke up every 6 minutes to push the bolus button. It was barely enough. They upp'd my dose at least once I know. Every breath hurt like hell. Oxycodone day 3-20. By day 20 I was down to 1/2 tab. Every day was a lot of pain, controlled by meds. I was sick of the pain and sick of the meds by the time it relented.

Summary, I did the side incision for purely vain reasons, I didn't want a "zipper". Am I glad I did, yes, would I make the same choice, yes. Am I happy now not to have sternum wires & pain to worry about, yes. Did I pay for that with more pain in the front-end, most certainly.

I'm just getting over a bought of bronchitis where I have coughed incessently the past 3 days. My incision is a little sore today finally as a result, nothing that rises to the level of pain meds. I've been amazed at how resilient it's been considering it's only 7 weeks post. The incision looks great, my ribs feel just fine, no different from the other side.

One word of warning..... EVERY NURSE will think you had a sternotomy and grab you JUST WRONG to pull you up or whatever. You have to say the type of incision you have and then they don't comprehend because they weren't listening or whatever. I had to show them my bare chest and physically point under my breast. The very first time this happened I didn't know any better and the nurse about killed me in pain by grabbing my right arm.

Hope this helps,
Ruth

 

[DuchessBear]

I also had a side entry for my MVR surgery, and my experience was similar to Joe's.

My scar is about 3 inches long, under my right breast. The surgeon went in between the ribs -- no cutting of any bone. A small incision in my left groin is where they hooked up the heart-lung machine. The most acute pain was during the first week or so, but was easily controlled by Percocet. Mostly it was muscle-type pain in the area of the chest incision -- the groin incision never bothered me at all, and I had no problems with my lungs. I took an occasional Percocet for about the first 10 days and an occasional Tylenol for about a week after that. I had very few restrictions on activity. I could do pretty much whatever I could tolerate. I was driving at about 2 1/2 weeks post-op and in rehab at 4 weeks.

As mentioned by others, the fatigue and lack of stamina is about the same for everyone, but you probably won't have to deal with as much pain.

 

[MaryC]

Hi Al,
I am 8 days post surgery from a port access mitral valve repair on 02/21. My incision is around 4-5 inches long directly below my right breast with a 2 inch groin incision that was used for the bypass. The ribs were spread, not removed and I had a pain pump on my right side for the duration of my hospital stay. To date I have not experienced what I would classify as pain....more discomfort. I was in ICU for around 30 hours for a total hospital stay of a little over 4 days. Initially I had a morphine pump, then they started giving me vicodine. These 2 pain medications did not agree with me as I experienced nausea during the couple of days I was on them. I was switched to Darvocet and it has been working fine and controlling any discomfort I have.

I will add that Adrienne from VR.COM put me in touch with a woman who had the same procedure a little over a year ago with the same surgeon. In the coversations I had with her leading up to my surgery, her pain experience was the same as I described.

 

[ALCapshaw2]

Hi Al,
I am 8 days post surgery from a port access mitral valve repair on 02/21. My incision is around 4-5 inches long directly below my right breast with a 2 inch groin incision that was used for the bypass. The ribs were spread, not removed and I had a pain pump on my right side for the duration of my hospital stay. To date I have not experienced what I would classify as pain....more discomfort. I was in ICU for around 30 hours for a total hospital stay of a little over 4 days. Initially I had a morphine pump, then they started giving me vicodine. These 2 pain medications did not agree with me as I experienced nausea during the couple of days I was on them. I was switched to Darvocet and it has been working fine and controlling any discomfort I have.

I will add that Adrienne from VR.COM put me in touch with a woman who had the same procedure a little over a year ago with the same surgeon. In the coversations I had with her leading up to my surgery, her pain experience was the same as I described.

Thanks for your interesting note Mary. I'm NOT fond of the Nausea and Dizzyness from most pain meds but a surgeon I interviewed recently gave me 3 COMPELLING reasons NOT to go through the Sternum for my 3rd OHS so I'm resigned to the side entry approach.

I UNDERSTAND about "discomfort" vs PAIN as that is my exact recollection of my two Sternal Entries.

Back Muscle PAIN and pain with breathing due to an 'irritation' to the chest wall by a drain tube are another matter! MASSAGE of the Back Muscles with a vibrating disk massager relieved that Pain VERY QUICKLY. It took a couple of weeks and many trips to different Doctors to get a proper daignosis of my breathing pain. One week of anti-inflamatories put me back on track to recovery.

'AL Capshaw'

 

[ALCapshaw2]

Another Question for you Right Thorocotomy recipients:

Do you know if your surgeon was able to CLAMP the Aorta?

One proposal for me was to 'let the heart beat' even though I would be on bypass (through the groin).

At a recent interview with the new member of the UAB surgical staff he revealed some interesting aspects of that approach:

There is increased risk of an Embolism (air bubble) coming from the heart. There are ways to deal with that but you certainly want a skilled and experienced surgeon who knows what to do and how to do it!

This surgeon also told me WHY that approach is taken with patients who have considerable scar tissue (often caused by Radiation Damage):

Besides the fact that access to the Aorta from the right side is difficult, there is the added complication that in Radiation Damaged patients, the scar tissue makes it difficult (to impossible) to differentiate the layers as the surgeon progresses through the scar tissue, i.e. he doesn't really know where he is and could damage other important vessels such as ByPass Grafts. (MY interpretation of what I was told)

This puts the "High Risk" message into Focus!
I guess that's why the first surgeon 'skipped the details'.

'AL Capshaw'

 

[ruth]

Al -

I don't know if the surgeon was able to clamp the aorta but I do know my heart was not beating, perhaps that's the same thing? Forgive my ignorance on this.

I'm a mitral patient and according to the surgeon the mitral valve was 'easy' to get to from the right thorocotomy incision because that's near the bottom of the heart.

She likened the layers after a 2'nd surgery to imagining a peanut butter and jelly sandwich that had been cut by a knife, everything kinda smushes together and the layers become indistinct.

Oh, and relating to the various back issues those with sternotomies have described, I really can't relate to them, I don't think rib spreading does the number on your back that the traditional zipper does. A few times I had a "runner's side ache" in my lower right rear back but it passed quickly, just a thought.


Wishing you the best Al,
Ruth