Worried

[Debrinha GT]

Hi there! I've often posted questions regarding scar tissue on multiple MVR redos as I'll be having my fourth at some point this year. But what i was wondering now is: How does it go for getting the sternum cracked open so many times, that is, is there a chance of it being glued on to major tissue, for instance? I know what I'm trying to say but I'm not managing to put it into proper words though. Hope you get what I mean!??
Hugs,
Debora

 

[Ross]

As far as I know, no, but you need to discuss this with the doctor doing the job. I know that's not a lot of help.

 

[ALCapshaw2]

I've discussed MVR with 3 surgeons and they all recommended using a Right Thoracotomy (through the ribs) approach for complex re-do's where there is a lot of scar tissue from previous surgeries (or radiation damage). This is especially recommended if ByPass Grafts are on the front of the heart.

'AL Capshaw'

 

[Debrinha GT]

Interesting

Interesting

Hi Al and thanks. I always thought this type of procedure could only be used in first timers. What does it actually involve and what are the advantages over the ones that are done throught the sternum? And what about the disadvantages? Is the recovery process easier ad less traumatic? Radiation? I don't quite get that? Is there radiation involved in OHS?
Debora

 

[Lynlw]

Debbie, I'm sorry you have so much to worry about these days, with everything going on. Justin has had 5 OHS the first one was a thoracotomy for his BT shunt and the other 4 were thru the sternum. Justin's heart is very forward in his chest and for the last 2 conduit replacements it was fused to his sternum w/ scar tissue. We knew it before surgery, because the pc was able to tell when he did his cath. The good thing is surgeons that have a lot of experience with multiple redos, (usually CHD/ACHD surgeons have the most eperience in multiple redos since many of the repairs are in stages) know the safest way to open you. When we were talking to surgeons, most of our questions were about how many surgeries they did on people that have had many surgeries and about opening him.For Justin they only used the saw part way thru the sternum, then carefully cut the rest of the bone w/ sizzors.(Justin thought it was a little too much detailed info during his preop appt, he is a "less I know the better" about what they are doing when he is asleep)Since the part of Justin's heart that needed replaced was in the very front,(his conduit was right under his sternum) they had to go in thru the front. For his surgery this year, they put him on the bypass thru his groin before they opened his chest, so there wasn't as much blood/pressure in his heart.
I know it is scary, but since many of the kids w/complex CHDs are surviving to adulthood, surgeons have alot of experience operating on someone that have had 4 or more surgeries. Do you know if internal scarring was an issue with your other surgeries? From what I know that is a hint if scarring will be an issue in the next one. That's not to say if you never had scarring before you definately won't, but some people tend to build more scars than others. Justin's surgeon couldn't believe the amount of scarring he had in just the 2 years between his last 2 surgeries, he even had scars forming in the 10 days between his surgeries this summer. Other people I know have had 5,6 surgeries and no problems with scars.Lyn

 

[njean]

Dear Deborah,

I can totally relate to your fears of scar tissue & the best way to a re-do OHS if necessary. I too am being watched very closely by my cardio because I will have to undergo a 4th OHS sometime in the future too. I have been told that the scar tissue underneath my sterum & even the back of my heart is so scarred up that it can be best described as a "clump of cooked spaghetti (spelling) that has fused" & the surgeon would have to separate strand by strand hoping he would not accidentally cut into a major vein or artery which could result in massive bleeding & perhaps death.

With all that I have been told, I just keep praying to God everyday & taking every day one at a time hoping to stave off this 4th OHS as much as possible. I only know that when it comes time, I will be looking for a surgeon who specializes in risky re-dos such as the ones we need. I have also been told that a "thoracotomy" as Al mentioned would probably be the best way to go but as I mentioned before, there's also scar tissue behind my heart! And so, I pray......

Take care of yourself & I hope you don't have to face a 4th anytime soon but if you do, get yourself the best surgeon available!