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Heart Disease (Expert Forum)
Miniminally invasive surgery for aortic valve replacement
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Miniminally invasive surgery for aortic valve replacement
by raylock, Sep 19, 2002 12:00AM
I am looking at an aortic valve replacement in the near future. It would be very helpful if I could compare the benefits and risks of the "J" minimal access incision with the port-access method. Could you provide some comparative risk/benefit information or point me in the correct direction to find this information myself. For example, I origionally believed that clamp time was greater for the port-access process but I now understand that not to be the case. There are major institutions which promote each of these methods and they apparantly do large numbers of them. Each method apparantly reduces hospital and recovery time as compared with the standard incision. I have read the archives and searched other internet sites but have not found this information. Thank you for your help.
Doctor's Answer
by CCF-M.D.-RCJ, Sep 19, 2002 12:00AM
raylock,
Thanks for the informed question. The bottom-line about this operation is that it is still in its adolescence. Some surgeons perform the operation well in the right patients. It is probably still the case that a conventional operation is better for high-risk patients or re-do patients. Younger patients likely fair about as well with the mini-incision as the longer incision, with better cosmetic results. However, post-operative pain, complications, and length of stay have not been consistently shown to be changed with the mini-incision.
You are smart to research different sites/centers. I think the best option is to see a surgeon who is skilled and experienced in both operations and let him discuss the options. The mini-incision should only be considered at a major medical center.
I've included 2 references below -- one had 120 patients, the other only 50 (both of these numbers are quite small).
Good luck.
Ref:
(1) TI - Minimally invasive versus conventional aortic valve operations: a prospective study in 120 patients.
AU - Machler HE; Bergmann P; Anelli-Monti M; Dacar D; Rehak P; Knez I; Salaymeh L; Mahla E; Rigler B
SO - Ann Thorac Surg 1999 Apr;67(4):1001-5
(2) TI - Partial versus full sternotomy for aortic valve replacement.
AU - Szwerc MF; Benckart DH; Wiechmann RJ; Savage EB; Szydlowski GW; Magovern GJ Jr; Magovern JA
SO - Ann Thorac Surg 1999 Dec;68(6):2209-13; discussion 2213-4
Thanks for the informed question. The bottom-line about this operation is that it is still in its adolescence. Some surgeons perform the operation well in the right patients. It is probably still the case that a conventional operation is better for high-risk patients or re-do patients. Younger patients likely fair about as well with the mini-incision as the longer incision, with better cosmetic results. However, post-operative pain, complications, and length of stay have not been consistently shown to be changed with the mini-incision.
You are smart to research different sites/centers. I think the best option is to see a surgeon who is skilled and experienced in both operations and let him discuss the options. The mini-incision should only be considered at a major medical center.
I've included 2 references below -- one had 120 patients, the other only 50 (both of these numbers are quite small).
Good luck.
Ref:
(1) TI - Minimally invasive versus conventional aortic valve operations: a prospective study in 120 patients.
AU - Machler HE; Bergmann P; Anelli-Monti M; Dacar D; Rehak P; Knez I; Salaymeh L; Mahla E; Rigler B
SO - Ann Thorac Surg 1999 Apr;67(4):1001-5
(2) TI - Partial versus full sternotomy for aortic valve replacement.
AU - Szwerc MF; Benckart DH; Wiechmann RJ; Savage EB; Szydlowski GW; Magovern GJ Jr; Magovern JA
SO - Ann Thorac Surg 1999 Dec;68(6):2209-13; discussion 2213-4
Did you get your question answered? The reply you received seems to have misunderstood your question. As I understand, you are looking for some way to compare the mini-sternotomy with the lateral thorocotomy (i.e. intercostal or "between-the-ribs") approach to minimally invasive heart surgery. Is this correct? If so, I am in the same boat.
Cleveland Clinic (and many others) use the mini-sternotomy while NYU (and only a few others) use the latter approach. It seems to me that the intercostal method is less traumatic even than the mini-sternmotomy. Yet, I can't understand why it wouldn't be more broadly employed if that were the case.
Can anyone shed any light on this for me. I'm so perplexed as to which way to go. C.C. has such a great rep but I'm drawn to NYU because of what seems to be so much less trauma using their approach.
Would appreciate any help on this!
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