Dr. Roselli Comments On Mini Sternotomy For Heart Valve Replacement
I recently received an interesting question from Emily about her upcoming aortic valve replacement.
Emily writes, “Hi Adam - After years of monitoring it, my aortic stenosis is now severe and I need a valve replacement. Yes. I’m scared. Yes. I’m confused. One thing I’m both scared and confused about is the cracking of my chestplate. Is it true that AVR can be done with smaller incisions to the sternum? If so, is that common?”
Mini Sternotomy Scar (3-inch Incision)
In case you are not familiar with the term, Emily is referring to a mini-sternotomy which utilizes a significantly smaller incision than a full, median sternotomy (which I had).
According to Brigham & Women’s Cardiovascular Center in Boston, Massachusetts:
- Mini-Sternotomy for aortic valve replacement incisions are performed through an upper mini-sternotomy, in which an incision is made from the sternal notch to the third intercostal space.
- Mini-Sternotomy for mitral valve replacement/repair incisions are performed through a lower mini-sternotomy, in which a 6-8 cm incision is made at the lower end of the sternum upward to the second intercostal space and extending into the interspace on the right.
So you know, my broken sternum incision is about 9 inches long. A mini-sternotomy incision is about 3 to 4 inches long. Ultimately, the benefits of a mini-sternotomy are less trauma to the chestplate and faster recovery.
Dr. Eric Roselli, Heart Surgeon, Cleveland Clinic
As for Emily’s second question, “Are mini-sternotomy procedures common?”, I contacted Dr. Eric Roselli, a cardiothoracic surgeon from the Cleveland Clinic to learn more. According to Dr. Roselli, “Almost all isolated first time aortic valves get a mini-sternotomy in my practice and I believe that’s true for my colleagues as well.”
I hope this helps Emily (and perhaps you) learn a little more about the difference between mini- and full-sternotomy.
Keep on tickin!
Adam Pick is a double, heart valve surgery patient and author of The Patient’s Guide To Heart Valve Surgery, a unique book which integrates the clinical facts of heart valve surgery with the personal experiences of an actual heart valve surgery patient. To learn more about Adam and his heart valve surgery book, click here.
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September 23rd, 2008 at 2:57 pm
Dang, I wish I could have had one! Not given the option! I’m 9 weeks post-op, and still a little sore from the big incision! Still better than no replacement at all. It’s eminently liveable-with! (Is that a word?)I’m now walking an hour and a half each day and feelinng much better.
I’d go with the mini one, if I were you!
Emily, I know it’s scary, but they are getting better and better with these things. We (all us ladies with mended hearts! ) are rooting for ya! (And the guys , too, I’m sure!)
Keep us posted!
Becca
September 23rd, 2008 at 5:32 pm
Adam- I have been reading your page after reading your book six months ago. I just had an Aortic valve replacement 11 days ago. My Surgeon Dr. Tsen out of Portland Oregon also used the mini for my procedure. I was out of the Hospital in 4 days and I’m already walking a half-mile 4 times a day. I have just about completely weaned my self off of the pain killers too.Your book and page have proved to be an excellant resource. keep up the great work. My advise to any person who is about to undergo this: Wash from your mind any and all negative or worrisome thoughts. instead focus all of your energy on the positive and make it happen. Plan for success.
September 23rd, 2008 at 7:49 pm
Hi Adam,
I read with great interest the information you provided on the mini-sternotomy for aortic valve replacement. I, too am waiting for AVR and as a woman would like to have a mini-sternotomy. Although Dr. Roselli states that “almost all isolated first time aortic valves get a mini-sternotomy in my practice” are there any differences between the two procedures with respect to surgical complications and long term outcomes?
Thanks,
Robin
September 24th, 2008 at 5:52 am
Emily, don’t worry about the incision. I had AVR three weeks ago, with a mini-sternotomy, and the incision site has never bothered me. I was muscle sore (especially on the left side) due to the other surgical procedures, but the incision site itself has not been painful and is healing very nicely. Relax, and have faith in your surgeon. You cannot control the surgery itself, but when you are awake, you can have some effect on your healing. Stay relaxed, be happy with small successes, and don’t forget to maintain a sense of humor! Good luck.
Sarah
September 24th, 2008 at 7:23 am
This is for Emily re: mini sternotomy from Julia Hightower, Winston-Salem, NC. I just had minimally invasive surgery to replace my stenotic aortic valve with a pig valve and this was done by Dr. Joseph Lamelas at Baptist Hospital of Miami, FL. He made a 2″ incision over my right breast and did not go through the sternum at all! I wouldn’t take anything for having the surgery done this way and highly recommend it to anyone who must have aortic valve replacement. There’s less time in the hospital, less chance for infection, less blood loss, and MUCH less pain. The surgery was done on Aug. 14 and I was back at work on Sept. 15. Good luck!! Julia Hightower
September 24th, 2008 at 1:43 pm
I also wish I had been offered the mini, definetly the most painful part of your recovery is the healing of the incision. But being 49 years old (and healthy) and looking at another 35 years of life makes any scar worth it! The stories I will be able to make up for the grandkids will be interesting!
I had my surgery on the 8th of Sept (Aortic Valve replacement along with a fairly sizable anyourism cut out on the ascending arch of my aorta), this is my first week back at work (full-time). I FEEL GREAT! Good luck with your surgery, don’t worry too much I am sure all will go well.
George
September 24th, 2008 at 5:42 pm
Emily: I am 71+ and participated in my second sternotomy in November. It was the full nine inches. I was out of the hospital in 3.5 days and walking in the hills of Connecticut in three weeks. I was in re-hab in the fourth week and playing tennis and golf in two and one half months. My surgeon is Dr. Sabet Hashim @ Yale-New Haven and his skills are tops for the entire U.S. The new Edwards Lifescience aortic valve is pumping very well and I have lots of energy and no pain. You will be a new person within six months of the surgery. Have a good ride!
Jim Hayden
September 26th, 2008 at 5:43 pm
Well pardner, where I’m from we do everything big. I was discharged yesterday, and my incision isn’t just nine inches, it’s nine feet, but luckily, my Cadillac Escalade hold me and that incision right fine.
Okay, apart from not owning an SUV, and having only a 9inch incision, everything else is true — I was discharged yesterday.
There is very little pain. The only pain comes from lying down in bed and trying to get out of bed.
A mini would have been very nice. Next time, I’m going to see if I can go robo.
June 19th, 2009 at 9:51 pm
I had the mini sternotomy in Feb 2000. Incision is no more than 3 inches and almost unnoticeable now. Recovery was quick and the pain was endurable. My question is- on a re-do operation are you likely to have another mini or would it be the full sternotomy? I know re-do’s are approached differently, because of the scar tissue.
I know Emily will be fine. The biggest hurdle is mental. You have to think positive, which I am lousey at, but that is truly the key.