MVP SURGERY- GOING THROUGH THE SIDE

[Patrice]

HI DOCTOR,

I AM GOING IN FOR MVP REPAIR/REPLACEMENT NEXT WEEK AND I WAS TOLD MY MY SURGEON THAT HE WILL ENTER IN AT MY BRA LINE.  I WENT IN FOR MY PRE-OP APPOINTMENT AND THE NURSE TOLD ME THAT THEY ENTER IN AT THE SIDE AND I WILL HAVE A SCAR FROM UNDER MY BREAST TO MY BACK (KINDA LIKE A HALF MOON).  THEY CANNOT ENTER IN THROUGH MY STERNUM DUE TO PAST SURGERY AND I WAS WONDERING IS THIS COMMON TO HAVE SUCH A LARGE SCAR?  I AM GOING TO ONE OF THE BEST SURGEONS (DR. STEVEN BOLLING @ U OF M) AND I KNOW HE KNOWS WHAT HE IS DOING I WAS JUST WONDERING WHY WOULD THE INCISION BE SO LARGE?  I WAS NOT ABLE TO ASK HIM PERSONALLY BECAUSE I DID NOT SEE HIM WHEN I FOUND THIS INFORMATION OUT.  I WOULD APPRECIATE YOUR INPUT ON THIS.

[shannon]

Hi -- for what it's worth (a patient's point of view), I had minimally invasive mitral repair in March.  In my case, which was pretty strange according to my surgeon, they found I also had a patent foramen ovale which required repair.  So I had both the under-the-right-breast incision and the median sternotomy.  The right side incision is not visible unless someone looks closely (and how many are going to do that?!?)  

My doc explained that your heart is really closer to the middle than we tend to think, and the right side incision gives them the amount of access they need without a huge incision.  Also, the left side of the heart is actually pointed toward the front of your chest, not toward the left side of your body (generally). So that's why the incision is done on the right side.

However, in my healing process, that incision healed faster but hurt more than the median sternotomy.  The doc didn't break any ribs, but they have to go through muscle and in between the ribs, so you'll be pretty sore.  My docs were extremely sensitive to pain issues, so I was never in horrible pain -- they took great care of me. That's been the general consensus from others who've had this surgery.

There's my two cents worth..

shannon

[Patrice]

Is it possible that ribs can be broken during this procedure?

Thanks again!!

[Alan]

Hello,

I just had that procedure done and the scar is about 4 inches under the right breast area.  good luck Alan.  ***@****

[Cleveland Clinic, MD]

I think it has to do with the surgical technique used - it's easier from that side but I'm not sure.

[Patrice]

Hi,

I do have another question.  Why would they enter in at the right side when the MV is on the left side?  Also,  can ribs be broken during this procedure?  Thanks for all your help and HAPPY NEW YEAR!!!!!!!!

[Nick]

HI DOCTOR,

MY FATHER IS 69 YEARS OF AGE.  HE HAD A TRIPLE BY-PASS 10 YEARS AGO.  IN AUGUST OF THIS YEAR HE HAD AN ANGIOPLAST.  THE TEST RESULTS INDICATE THAT HIS RCA IS 100% BLOCKED AND ONE OF HIS LEFT CORONARY IS 80% BLOCKED.  HIS LEFT CIRCUMFLEX IS 100% OPEN AND TWO STENTS WERE ADDED AT THE TIME OF THE ANGIOPLANST THIS AUGUST (ONE UPSTREAM FROM THE ORGINAL BYPASS GRAF AND THE SECVOND DOWNSTREAM FROM THE GRAF). THE DOCTORS SAY THAT THE BLOCKAGES ARE IN THE SMALLER ARTERIES FURTHER DOWNSTREAM FROM WHERE THE BYPASS WAS DONE. HE IS ALSO SUGAR DIABETIC.  SINCE AUGUST (99) HE HAS HAD 6 MILD HEART ATTACKS.  HE IS IN CONGESTIVE HEART FAILURE AND CONTINUALLY GETS WATER IN HIS LUNGS.  HE IS TREATED WITH LASIX TO GET RID OF THE WATER PROBLEM AND THEN SENT HOME UNTIL NEXT TIME. OTHER MEDICATIONS INCLUDE NITRODUR, NORVASC, DIGOXIN, PLAVIX, ATENOL, LIPTOR, FUROSEMIDE AND CODED ASPIRIN. HE CANNOT HAVE BYPASS SURGERY BECAUSE OF HIS SUGAR AND IS NOT A CANADIATE FOR HEART TRANSPLANT FOR THE SAME REASON.  I UNDERSTAND THAT THERE MAYBE OTHER ALTERNATIVES AVAILABLE IN THE UNITED STATES.  OUR MEDICAL PLAN COVERS ANY TREATMENT IN THE UNITED STATES THAT IS NOT AVAILABLE IN CANADA.  DO YOU HAVE ANY RECOMMENDATIONS OR SOMEONE I CAN CONTACT TO FIND OUT MORE INFORMATION?

[Cleveland Clinic, MD]

This is a standard approach and the scar is not as large as you are thinking it will be.  Also it is less noticible because it runs under the breast and arm.