Thoracotomy Vs. Sternotomy For Vicki’s Mitral Valve Surgery… Any Female Perspectives?

I wish you the best with your surgery, I am not far behind you having just met with Dr. Gaudiani last week. Like you I am hoping for MR repair.

My research has surfaced the consistent report that thoracotomy is more painful that sternotomy. Also, I wonder how long it is that one simply cannot wear a bra?!!

On the other hand the thoracotomy scar will likely limit one’s ability to wear v-neck shirts and many bathing suit styles.

I too wish you the best with your surgery. I had minimally invasive MR repair in May and wore a bra home from the hospital. I actually found it to be more comfortable. I know you wanted response from people who had surgery more than a year ago but I think you will be able to resume your activities quickly. My scars are fading already. My only problem has been with the groin incision which has caused numbness in my leg which makes stairs a chore. Pain was managed with tylenol for several weeks. Minimally invasive is nothing like what Adam went through!

Dear Vicki, My mother just went through a valve relacement with the same Doctor! He is the best in the field. She had the procedure where they break the bone,but apparently this was a better option for her. I am studying to be a Naturpathic Doctor and I know quite a bit about both Alternative and Alopathic medicine. The thoractomy is a bit more taxing on the muscles. You will definitely need to lay off the exercise while healing doue to muscle fibre repair and a certain level of pain. You are in Good hands. All the best. Heal well. Sincerely Erica Iantorno

Vicki,

I had the thoracotomy on July 16 (2 months ago today) for mitral valve repair and aneurysm repair. Not having the sternotomy I can’t say which is better but I was told that the recovery time for the thoracotomy is much less. I, like you, am quite active, 51 years of age and I feel that the recovery is going better than I imagined. In the beginning you feel some pain in your ribs each time you breathe in which the doctors say you don’t feel with the sternotomy but your healing time is quicker. My scar is only about 2 1/2 inches long and then you have one on your leg plus 5 or so smaller ones around the main incision. I started cardiac rehab yesterday and felt really good. I also went back to my old exercise class (aerobics, cardio and weights) last night and was surprised at how much I could do. If you have the opportunity to go to rehab I would recommend it just for your piece of mind. Initially, it is very scary not knowing what you can and can’t do especially if you are normally very active. The only thing I was told not to do was weights for another month. I have never felt better!!! If I were you I would opt for the thoracotomy – highly recommended by my surgeon. Good Luck!

Vicki,

I am a 44 year old female. I had a thoractomy five years ago to repair a mitral valve. It takes a little time but you will get your mobility back and will be able to do all your activities. I work as an athletic trainer at a large high school. I take care of injuries to athletes on the field and rehabilitation in the clinic (including big football players). The surgery did not limit me and I was back working in a couple months.

As far as long term effect; I do have a loss of sensation in my right breast. Something my surgeon neglected to tell me. But it was a minimal trade off. I was wearing a bikini two months after surgery.

I agree you should go to cardiac rehab. It helps give you the confidence to go back to your active lifestyle.

The most important advise I can give you is to find out the number of thoractomies/mitral valve repairs your surgeon has performed and his success rate. This is something the office should have. Sounds like you are in good hands by the other comments but it doesn’t hurt to have all the facts.

Hope this helps. Good luck on your surgery and remember to give yourself time to heal.

Thanks to Adam and ALL that have answered my post. I’m leaning toward the thoracotomy…altho this is the first I’ve heard that the right breast may become numb. I will definitely ask Dr. Gaudiani about that risk at my pre-op vist. I had a left breast mastectomy 15 years ago (I’m doing great!), and don’t like the thought that my remaining breast may lose feeling.

Again, thanks…it helps to hear from all of you that have walked this road ahead of me!

I had mitral valve repair and MAZE procedure through a right thoracotomy on July 16 at Cleveland Clinic. It was an extremely painful procedure and left me with a lot of numbness and pain in my leg and right breast and chest. A lower sternotomy was planned but my surgeon changed the approach the morning before surgery so I did not have the opportunity to research. I was told by the staff that the right thoracotomy is more painful but I am reassured that in the long run it is a much better choice. I know that is your concern. Immediately following the surgery I was very angry about the level of pain for the trade off of cosmetics (I am 39 years old). Over the last two months as the pain has improved I am letting that go. You should also thoroughly discuss the risks of conduction system and rhythm issues with your surgeon also. That is what I am dealing with now. I wish you the best of luck.

I had the minimally invasive procedure to repair my mitral valve 6 weeks ago. As I am in my early 30s, I was pleased the surgeons were able to repair my valve through such a small incision. While you can’t avoid the initial pain, it was relatively short lived. I still have some residual soreness and a little numbness, but nothing compared to the discomfort and pain experienced with a sternotomy. I am already back to the gym and doing some light weights.

I am having mitral valve surgery on 1/5/09. I am a 58 yr.old, active (long distance runner, weights/strength training) female. I too am faced with the decision: sub-mammmary thoracotomy vs. minimally invasive sternotomy (6 inch incision). I am most concerned about residual pain/functional issues; and least concerned about cosmetics.
I am wondering what choice Vicki made; as well as any further input from others.

I’m 3 weeks post-op, mitral valve repair via thoracotomy. I did have a couple dicey days of poor pain management. The key for me was the addition of ibuprophen. It took care of the bone pain while darvocet kept the incision pain at bay. The combination has been working perfectly. (Also, using a pillow to prop up my right arm helped to take pressure off the incisions and rib.) Once the pain was under control, my rate of recovery greatly increased. Each day is noticeably better. With regard to breast numbness, my understanding is that using the mammary blood vessels for the heart lung hook up can cause this to happen. My surgeon used the axillary blood vessels leaving a 1 inch incison at my arm pit. So far I haven’t noticed any numbness around my breast. Best wishes to all.

I had a mitral valve replacement via sternotomy in August 2007. I thought I was going to die immediately following that as no one prepares you enough for the initial aftermath. Now I’m 1 1/2 years post surgery and generally feel good. I still have pain when my 3 year old presses on the incision and find that I am probably over cautious with my activities. I was told that cardiac rehab was not needed for my valve replacement which I don’t think I now agree with. I’m told that there’s not always a choice on type of surgery which depends on what the surgeon believes will work best with replacement vs. repair.

I have moderate mitral regurgitation, with paroxysmal atrial fibrillation and atrial flutter. I have had 2 unsuccessful cardiac ablations , one where they severed my carotid artery, and another 3 weeks ago where they cut my femoral artery. I stiil have atrial flutter and don’t not want another ablation. I am leaning towards a minimally invasive mitral repair as think this may be the major cause of my arrhythmias and wondered who is the BEST surgeon to see in the Philadelphia area and if there is none here,who is excellent, I will travel anywhere! I am more or less housebound now, heavily medicated to keep the flutter away so I don’t need to have another cardioversion. I had 2 last week alone! Please advise me.I am a very trim, active 68 year old who is generally very healthy and has an extremely healthy life style. Yhank you!

I am a 69 year female. Have just found I have a tricuspid valve with regurgitation. I am alone and would like to know if any one has taken care of them self. Is this possible?

I am 35 and recently had mitral valve repair and was very glad to have someone staying with me after my surgery. I think at the very least you need to have someone come daily and help you out. Even basic house hold chores are very difficult after such a major surgery. Good Luck.

Hi, I am 47 year old male. 3 weeks post-op from Mitral Valve repair via thoracotomy. In the last two days I have increased my walking to about 2 miles a day. I did have help when I came home. I would recommend at least 2-3 weeks help. At 2 1/2 weeks I began basic household chores, dinner for the family, etc. I still have a slight bit of discomfort, but sleep on my right side and am not taking anymore meds. I did have a lot of problems with nerve damage to my femural artery from the heart lung machine, but in the last two days the pain has subsided, only numbness exists. Hope this helps

To add to Vicki’s story:
I had a recent mitral valve repair done with a 6″ sternotomy incision. I had the possible option of having the repair done robotically but my physician Dr. Bakhos with Loyola Hospital in Chicago recommended to do a sternotomy because the robotic repairs take longer. My mitral valve had both anterior and posterior leaflets gone bad plus a small growth that needed to be removed from the ventricle and Dr. Bakhos felt I would be on the heart-lung machine too long. In this day and age of mitral valve repair, I would recommend if possible going to a hospital that has the da Vinci robotic system available and making that your first choice.
For the record, I had the surgery Monday March 30 and left the hospital Friday with only Tylenol for pain. Once they pulled the chest drains out on Wednesday, you couldn’t keep me in bed and I got better in leaps and bounds. As far as pain, sternums have only skin and bone, while ribs have nerves in between them, plus they REALLY spread those far apart with retractors to get in through that small hole. I was told they were more painful incisions. As far as looks, I am a RN who works on a cardiology floor and I see patients all the time with open heart scars; they fade to almost nothing. While I am vain enough about my body to exercise with a Soloflex and ride miles on my bike to keep my weight to 113# (age 50), all I cared about my incision was whatever was the easiest way for my surgeon to get his job done and done well.

Hi Vicki: I’m guessing you probably had your surgery already, but I’m curious as to which approach you chose and how it worked for you. I am a 47-year-old extremely active woman who had experienced 30+ years of what I was told were “ophthalmic migraines”. I would lose my vision for 30-60 minutes at a time with (rarely) expressive dysphasia; sometimes as often as 3-4 times in a week, but normally once or twice a month. When I had an episode that lasted 5 days, a thorough workup revealed a retinal infarction (TIA). Further workup revealed a large atrial septal defect with an atrial septal aneurysm.
Like you, I weighed my options as to the approach in which to repair these. I opted for the thoracotomy. As stated above, yes, it was quite painful; although I’ve never had a sternotomy and have no basis of comparison. I had no complications and the doctor gave me the OK at 6 weeks for activity as tolerated. I started working out slowly and within a month or so after that, was up to full speed.
Now, almost 2 years later, I am in perfect shape (in fact, completely dismissed by my cardiologist!). No one even believes I had open heart surgery. I have a small 1′ scar on my neck from bypass that is barely visible as well as one on my upper thigh and a 5-6″ scar under my right breast. I feel as if I never had surgery with the exception of (as with Tanya above) some nerve damage in my right breast resulting in both hypo and hypersensitivity. A small price to pay.
I’ve also never had a “migraine” again. Obvisouly they were never migraines. According to my doctor, they were clots (small TIAs) all along. I am so fortunate to be alive and am thankful every day for my wonderful doctors!

Good luck!

Would love to hear from someone! I am a 51yr. active female, who had minimal invasive mitral valve repair and a maze procedure, Dec. 7th. I have such pain where the incisions are and my right breast. What do to for it?

Vicky, I also had a left mastectomy, almost 5 years ago. Would love to chat. Here is my email:Shariwest@aol.com

I heard going down the middle is very painful, and more time to recover. To be honest, tomorrow will be 4 weeks since my surgery. I have SOOOOO much pain. Going tomorrow to the cardiologist. Surgeon seems to think everything is a okay. The pain is awful. I am wondering if something is going on.

Hi Shari,
I am a 58 year-old woman. I had a “minimally invasive” mitral valve repair Nov. 23. The repair was done through a mini-thoracotomy, about a five inch incision under my right breast. I also had about a three inch incision at the top of my right leg for the heart bypass machine.

Minimally invasive is certainly a misnomer. It is less invasive, but now I see that it has its own set of issues. The incisions were very painful the first week. That went away for me, but my right breast is numb, and my right leg, from the groin to the knee is somewhat numb, but also hypersensitive to the touch. The groin incision has a ton of scar tissue,and it swells and gets sore after I have been on it or walking.

My right chest is still tight and is its own percussion section, with all sorts of clicking and clacking of ribs! I have also had a lot of shooting pains through my breast and it does hurt to the touch, but I think that is because the nerves are starting to regenerate. Maybe that is what is happening to you.

I do think that I was more mobile quicker than if I had a sternotomy. But most people don’t understand that the surgery was just as brutal, that it was still open-heart surgery which included collapsing your lung, going on bypass machine. So you don’t get as much sympathy as if you had your chest cracked!!!!!

I hope this helps. I haven’t been able to compare notes with anyone who has had the thoracotomy.

FACING MINIMALLY INVASIVE MITRAL VALVE REPAIR AT DUKE UNIVERSITY IN 3 WEEKS WITH DR GLOWER. ANYONE EXPERIENCED WITH THIS PROCEDURE AT DUKE? I AM VERY TERRIFIED AND NOT SURE IF I CAN GO THROUGH WITH THIS OR NOT. SCARED ABOUT PAIN AFTER SURGERY AND DRAIN TUBES AND NERVOUS ABOUT REPAIR BEING SUCCESSFUL AND NOT NEEDING ANYTHING FURTHER DOWN THE ROAD. ALSO WORRY THAT I AM TO YOUNG AT AGE 36 TO HAVE THIS DONE. CAN WAITING BE THAT BAD ON HEART?

Christy, I too am a 36 year old recovering from mitral valve surgery. It does seem too young, but the damage is real. With bad valves the heart muscle can become enlarged and weaken, THIS CANNOT be repaired and can eventually lead to congestive heart failure, best to get the valve fixed before there is permanent damage. I am a nurse and have worked with many heart failure patients, I knew this was a greater issue to fear than surgery. I was absolutely terrified going in, it is a major surgery. My heart now is performing better than prior to the surgery and that is a comfort. I had to have a median sternotomy, and it has been painful, there are pain medications and rehab to aid us in our recovery. In addition, the healthier you are going in, the easier it is to recoop. I hated the anxiety prior to the surgery, and set up my surgery for as soon as I could so I did not prolong it. I am a year out now and not quite 100%, but I know my future is much more secure now.
I had no symptoms before my repair which made it very difficult to believe that I needed surgery, but my heart was enlarging, in the case of heart muscles, bigger is definitely NOT better. Best wishes

Hi Everyone
Don’t know if this helps anyone above but I am a 60 year old female who underwent the full crack the chest open surgery Oct 1/09 to repair a mitral valve. The repair went well, I was in the hospital the average amount of time and have to admit I still suffer breast pain and shoulder blade pain. The pain is definitely much, much less than what it was originally but it is still there and I am told, will eventually subside altogether. I don’t take any drugs for pain and haven’t since my second week after surgery. My sternum has healed but now and then lets me know it had been under construction. I found the actual surgical pain only lasted the first few days and by the third day I was on Tylenol Extra Strength and the next week, nothing. Knowing my heart has been repaired is definitely worth the quality of life I am going to have. Would I do it again? In a heart beat! But, I pray I don’t have to!! Cheryl, Ontario

Hi Christy, I had mitral valve surgery six weeks ago as I wrote above. Despite the strange array of after effects I am very glad and relieved that I have had the surgery.

Once I found out that I had a major leak, I wanted to get it over with as soon as possible. FInding the right doctor and facility was very stressful, and the anticipation of the surgery was worse than the actual surgery and recovery. Once I commited to a course of action, the process just took over.

The recovery process has been kind of like training for an athletic event. I have seen dramatic improvement in my energy and physical capacity from the first week I was home. I am now looking forward to starting cardiac rehab. and seeing just how fit I can now become.

Those of us who have had valve surgery needed to have it to be able to get on with our lives. Good luck.

THANKS LISA FOR THE REPLY. IT HELPS TO KNOW SOMEONE MY OWN AGE HAS HAD THIS DONE. SINCE YOU ARE A NURSE I KNOW YOU HAVE SEEN PATIENTS AFTER THE MINIMALLY INVASIVE OR KEYHOLE APPROACH. WHAT DO YOU THINK ABOUT THIS? ALSO HAVE YOU HEARD ANYTHING ABOUT DUKE UNIVERSITY OR DR GLOWER. I HAVE BEEN TOLD HE HAS LOTS OF EXPERIENCE IN THIS KIND OF THING AND HE DID TELL ME HE WOULD BEND OVER BACKWARDS TO TRY AND REPAIR MY VALVE AT MY AGE. EVERYONE SAYS DUKE IS A GREAT PLACE BUT THAT STILL DOES NOT KEEP ME FROM HAVING SECOND THOUGHTS. I KNOW I AM JUST WAITING AND LOOKING FOR SOMEONE TO TELL ME I DON’T NEED THE SURGERY AFTER ALL AND THAT IS NOT GOING TO HAPPEN.

A heartfelt hello to all of you, and the wonderful support and information you are providing for one another. My name is Wendy. I am a 54 year old, active kindergarten teacher who also loves yoga. I am scheduled for a mitral valve repair on 4/14/10. My doctor at Mercy Hospital in Sacramento, has also given me the choice of a thoracotomy or midline sternotomy. I would greatly appreciate the thoughts and tips from those of you who have gone before me, your words of wisdom, and any advise or tips for my family as well. Many thanks! Wendy

Hi Wendy, I am 58 years old and had mitral valve repair through a thoracotomy Nov. 23. I have written a few comments above in this blog already concerning my experience. I was happy with my choice of methods, but frustrated before and after because there is so much written about recovery from a sternotomy but little guidance concerning the thoracotomy. I would be glad to try to answer some of your questions. I don’t know whether we can exchange e-mails on here.

Hi Wendy,
Thank you so much for responding to my request for more information and insight on having a thoracotomy. It would be so helpful to be able to hear more from you. I haven’t been able to talk with anyone personally who has been through the experience, and because of the privacy laws my doctor hasn’t been able to connect me with anyone to talk to. I told his office that I would be happy to be a patient advocate after my surgery. The unknowns and uncertainties make facing the surgery so much more difficult. I am very grateful to Adam and all the participants of this blog who are building a circle of support and information for each other. It is a gift that keeps on giving and touching lives to those in need. I will write him and ask him how we might be able to connect more directly. Thank you again. Be well, Wendy

I am a 55 year old female and almost 1 year post op from a minimally invasive mitral valve repair in Houston. “Minimally invasive” doesn’t mean “minimally painful,” although no one told me that beforehand. I can honestly say it was the most excruciatingly painful thing I have ever been through, and there is little or nothing written about this type of surgery on females. The first two weeks were the worst,but I rapidly improved after that. Having sufficient pain meds and someone to help out the first week home is very important. I had a couple of complications – had to have fluid drained from my chest a couple of weeks after surgery and I also developed a lymphocele at the groin incision which required another surgery. All in all, I am very pleased with the results and have no regrets about anything. I feel great and am able to exercise and do anything (and more) that I could do before the surgery. I had lingering breast and shoulder blade pain and recently received a couple of rounds of steroid injections which has helped.

Has anyone experienced strange muscle contractions under the right breast when the chest muscles are flexed? If so, has anyone tried to get it repaired?

Hi, My younger sister(49) needs a mitral valve repair in 2-3 months for severe prolapse and regurgitation, ruptured cords, pulmonary hypertension, enlarged heart. The head of UW Madison advised her to have a full sternum approach. Mayo says she is a good candidate for robotic. Northwestern head of cardiac surgery says full sternum.She is going to consult with the Univ. of Chicago also. We are very interested in the healing time and complications from the minimally invasive technique vs traditional approach.The UW surgeon was the one who mentioned the rib pain, muscle pain and possible right breast numbness. She wants to avoid the big scar but also has 4 teenagers and is otherwise athletic and in good health. Her lungs need to recover for a few months more from severe H1N1 and pneumonia last winter according to one of the surgeons. I would appreciate input, especially for small boned females having had both techniques. Thank you.

I am a 30 year old female in need of an aortic valve replacement. I am still trying to decide between a thoracotomy or a full sternotomy. Worried about tubes, pain, etc. Not much concerned about scars. The anxiety is killing me…my surgery is still a month away. I just want to make the right decision. I am having the surgery in Utah. Any suggestions or comments from anyone is appreciated! Thanks!

Hi Melisa. At 40 I thought I was young to need a valve replacement. Like you, I need to decide which type of sugery I want. My surgeon says the only difference is the size of the incisions…. I also need to choose which type of valve I want (porcine or mechanical). I’m curious to know which you plan on choosing. I was leaning one way but am giving more consideration to the other lately. My surgery is scheduled for mid-July.

I am a 48-year old male in good health who is scheduled for mitral valve repair (prolapse and regurg) in August. Regarding minimally invasive partial sternotomy v. thoracotomy, Dr. Keith Horvath of NIH and John’s Hopkins said that the thoracotomy was more painful. More interesting, he said that, if you are athletic you might consider sternotomy because the sternum can actually become stronger after surgery because it is held together by steel wires rather than “just” bone. He added that thoracotomy can sometime leave lingering or chronic little pains because it requires cutting through muscle and connective tissue rather than skin and bone. There are many other considerations, of course, but those who lift weights or swim should think about this.

Another interesting tidbit he mentioned: connecting the cardio-pulmonary bypass machine through the femoral artery (as is often the case in minimally invasive techniques) has, according to a recent as-of-yet unpublished study at NIH (?), a slightly greater chance of causing stroke. A possible reason is that the blood flows BACKWARDS through the femoral artery, possibly dislodging stuff that shouldn’t be. Going through the aorta, on the other hand, goes with the flow, so to speak. Further, the femoral artery is small, and more difficult to work with than the aorta. . . . Has anyone else heard anything like this? I don’t like the idea of blood flowing backwards in my arteries. (Maybe I misunderstood.) (Of course, the chance of these side effects is very low.)

I’m a 69 year old female who is quite active. Don’t run, climb mts. etc, but work outside in my yard doing whatever needs doing.moving heavy pots, climbing ladders – painting , digging holes , hauling stepping stones etc. have had mitral valve prolapse for years, and have to stop and rest a lot. Doctor says I need replacement surgery but even tho the valve is getting worse, my heart is still too strong for surgery to be done now. Don’t understand why my heart needs to get so weak first. He said the danger of dying from the defective valve has to outweigh the possibility of dying during surgery. I currently take no medicines for anything beyond asprin or ibupropen for arthritis or something for bouts of sinus. Doctor said I will have to have a metal valve and take blood thinner forever. I wonder how many more drugs will I end up having to take before it is over. I hate to take medicine. The thought of pain doesn’t upset me nearly as much as being down where I can’t look out for my self for who knows how long.

FYI, I had my surgery, and everything went as well as could be expected. Oddly, I didn’t have much pain in my chest afterward, except when coughing. Even then, it wasn’t terrible. The painkilling narcotics did give me hallucinations, though.

At age 68 I had robotic repair of the mitral valve in May of this year. Ten days later, I suffered a rare complication, herniation of the lung into the robotic incision after a severe coughing spell. I underwent surgery to repair this. The recovery was extremely painful following both surgeries, worse after the second. At five months post op, my right breast is still completely numb and I expect it will remain so. By all indications, my heart is healthy and I am taking no heart or pain meds.All in all I am grateful to have my life back.

A year ago at the age of 54 I was diagnosed as having a large Atrial septal defect ( 29 mm) which I would have been born with .
In May 2010 I underwent keyhole surgery to try to repair the hole with an amplatzer device – this failed due to the position and size of the hole.

My Dad died shortly after this and so I had to deal with the grief before trying to move on. I have seen 2 surgeons recently . One is based in my home city in Wales and says he can use either a sub mammary ( is the same as thoracotomy> ) approach or a full sternotomy . He would not show preference – just said the sub mammary takes longer and is more taxing for the surgeon , but that time on by-pass the same . Also that there is a risk of ongoing pain afterwards .
The second surgeon is based in London , and definately favours the sternotomy . I was hoping he would attempt a lower sternotomy ( some of you have mentioned 4 inch incisions ?) but he laughed and said with women he tried to make the scar slightly lower but that was the best he could do . This surgeon has a very good reputation , but seems more traditional .

I am scared and confused . Can anyone help me ? Most of you seem to be from America sharing your information- well done . I can’t find discussion groups like this in UK .