Surgery

[allan]

I am at the point to where we know I need to repair or replace my  mitral valve . I heard from a patient that has gone to your facility that you don't do the minimal invasive technique for this condition.  I was refered to another doctor in another state for the surgery due to the fact that I did have atril fib on two occasions.  I have had atril fib,(probably due to enlargement is what they think) but I am a very hyper and stressed out person as well and feel fine with exception to ocassional breathing difficulty which seems to have gone away since 15 lb weight loss.  have two questions for you on with these facts.  What are the requirements that they go by to see if you are infact a candidate for the maze technique. I don't know that I am since as I said I have had only 2 cases of it and both lasted about 1.5 days.  I do get a lot of arrythmias, have just started on q10 and magnizium and I find the valsalva allways corrects the arrythmias.  My last question is what are the advantages and disadvantages to the minimal invasive technique along with the risks and if you have time can you explain the procedure for the minimal technique.  You see I was refered to a doctor out of state by my physcian but if I am not to have the maze done and am not a candidate for the minimal technique I would rather stay here and have my physcian do the surgery.  Thanks again, for all the time spent helping all of us.

[CCF CARDIO MD - DLB]

Your friend was incorrect - we do the minimally invasive mitral valve repairs here.

Based on what you have written, I do not consider you a candidate for the Maze procedure. You have only had a couple of short episodes of afib; the Maze procedure would be an extreme option to consider in your case. Potentially, the arrhythmia episodes that you feel would quiet down once you have the valve surgically fixed.

The only potential disadvantage of the minimally invasive technique is that the surgeon does not have as complete a view of the surgical field. This makes the procedure more technically difficult; thus, you would want a surgeon with some expertise in this area. Regardless of the surgeon, there is always achance that the minmally invasive operation will be converted to a standard operation in the operating room.

[shannon]

For what it's worth -- I went in for a mitral repair using the minimally invasive approach.  When the surgeon got into my chest, they found a little complication (I had an ASD that also required repair) and they had to go to the median sternotomy approach.  Although I've been told by two friends who had the minimally invasive approach at CCF that their recovery was pretty easy, it's still open heart surgery and there's still a certain amount of pain to go through.

My point here really is that the approach to your surgery is not the most important thing.  The most important factor is the experience of your surgeon, and the trust you have in him or her.  Don't worry too much about the surgical approach -- you'll heal from either incision.  What you want is the best possible surgeon doing his or her best work.  How they get in your chest to repair or replace the valve shouldn't really be your biggest issue.

My two cents!

Shannon

[CCF CARDIO MD - DLB]

I agree with this. Heart surgery is major surgery, regardless of the approach, with serious risks. While minimally invasive surgery does produce a smaller scar and usually has a slightly faster recovery time, it still has associated pain, sometimes even moreso than the conventional approach.

[allan]

Thanks for all the opinions and I guess since I am in a business where I am the one that brings in the money, I was trying to get back to work as fast as possible, and since my work is somewhat physical I was looking for the quick approach.  I really did not think of it in that manner that the approach should not be the concern, more the quality of the work at the time of surgery.  If they do a better surgery with the full approach I may have less problems down the road.  They did say that I have a lot of posterior damage such as torn cords and slight damage to the anterior but only one side of the valve is damaged so they will try to repair it.  What are the requirements prior to being seen at your facility,,, I have had a TEE, standard echo, ekg, stress test, and all blood work,, I am 44, is a cardiac cath necessary prior to surgery and if so how do you tell who needs it and who doesn't.  I weight 220 lbs am about 6 foot 1 inch and am in good health over all. Last statement is in regard to my first one,  can you sell me in the less invasive approach how is done, briefly, do the remove a rib, loosen them or what, and do they use optical equipment from another location. Thanks again.

[CCF CARDIO MD - DLB]

It would be important for you to bring all test results with you (not just the papers, but the tapes with the echo pictures). We would decide if the quality of tests already performed were adequate; if not, we would repeat whatever tests were necessary. The need for cardiac catheterization depends on your risk factors for heart disease, the results of your tests and the cardiologist/surgeon performing the procedure. If a stress test with imaging is negative and you have no symptoms and risk factors for heart disease, some cardiologists will omit the catheterization. Many would still perform a catheterization in an American male over 40.

The minimally invasive approach involves a much smaller incision. It involves spreading of ribs and usually removal of a small piece of rib. The recovery time for people who need to do manual work is shorter than with conventional surgery.

[allan]

I noticed a post that asked a life span of a mechanical valve.  I had talked to a physician and he said the valves that are used today will last 100 years, My question is are the valves used today more improved to give this type of year expectantcy and if so what are the differences in years expected for old to new.  Are the valves used for the mitral the same as the ones used for other replacement valves? I do appreciate your site since I feel most people have trouble talking to their physician as the questions usually come up after they are out of his office. Do they try to use the pig valves anymore, I heard they are good for 10 years or so?

[CCF CARDIO MD - DLB]

The hope is that a mechanical valve will last the patient's lifetime. There is always a chance of clot or infection reducing its durability, though. This risk exists with the pig valves also, which are still in use. In general if someone is young with a presumed life expectancy of several decades, a mechanical valve is preferred over a pig valve.

[Elaine]

I had mitral valve repair done in my home town in the summer of 1997.  I did not ask the most important question to my surgeon...how many of these have you done?  6 weeks after the repair, a leak in my aortic valve was found, which needed repair. The next summer I was again facing surgery. This time, with the help of my cardiologist, I went to Cleveland Clinic.  Dr. Cosgrove was able to repair the damaged aortic valve. I am not trying to scare you, but must emphasize how important it is to get a surgeion who has expertise and experience.   A friend had recommended Cleveland the first time, and I thought this would be too inconvenient for my family (young children).  When I was there, I realized how any people from all over the world seek treatment there. Just something to think about!