Mini-Thoracotomy For Heart Valve Replacement… Jim’s Story

Interest in minimally invasive procedures for heart valve surgery is increasing for both medical device manufacturers and patients. As we learned last week, Medtronic spent over $1 billion to acquire CoreValve and Ventor Technologies, two companies that specialize in non-invasive valve replacement technologies for diseased aortic valves.

From the patient perspective, the advantages of minimally invasive surgery are (i) less post-operative pain, (ii) faster recovery and (iii) lower mortality. As you have read in this blog, several of my readers have had such procedures including non-invasive robotic surgery for mitral valve repair.

Over the past few months, I’ve been receiving additional comments about minithoracotomy for aortic valve replacement and mitral valve replacement. In this type of cardiac surgery, the patient does not have a median sternotomy in which the sternum is broken (as discussed previously in “Vicki’s Thoracotomy Versus Sternotomy“).

Given this topic, I just received a very interesting patient story from Jim Engelmann. Jim, as pictured below, recently had aortic valve replacement via mini-thoracotomy.


Jim’s Mini-Thoracotomy Scar After Valve Replacement

Hi Adam,

Well, I went for it!  I had the minimally invasive surgery through a mini thoracotomy on January 19, 2009.  I really had faith in my surgeon, Dr. Narendra Sastry. I believed he had a thorough process just in case there were any problems.

My medical team did not have to break the sternum. Instead they entered my chest from above the heart.  The operation went well, and I was off the tube before being brought to post-op. The operation took 7.5 hours which was very tough on my wife.  I stayed in the intensive care unit (ICU) for four days – mostly because of fever and the need to keep my chest tube in longer-than-normal.

As for recovery, I was doing well until Saturday when I went into A-FIB.  Then, on Sunday, a fever made them start drawing cultures.  I was in the hospital until Sunday when they decided that there was no infection, just contaminants on the cultures.

Unfortunately, my coumadin was over-prescribed, which made my INR skyrocket to 14.  I went back to the hospital on Friday for vitamin K shots and other precautionary treatments. Today, my INR is a 2.2.  While this is too low, we’re bringing it back up slowly.I took a ten minute walk outside this evening, and I’m feeling stronger than at any other time during this procedure. I hope that they can get the INR under control quickly.  Once that’s better, I will feel better.

In the meantime, I am thankful for the mechanical valve clicking noise in my ears and the 4 inch scar on my chest. I took a picture today (shown above) for the first time.  My wife was not a big fan of photos.  What you’ll see is a small scar on my right chest (mostly scabbed over).  I do have three incisions on my right side, two from chest tubes and one as part of the procedure, but they are almost invisible at this point. The other incision (that I did not photograph) is in the right groin, and 8 inches long. It is also mostly healed.


Adam’s Median Sternotomy – One Week After Surgery

It’s my 4 week anniversary, and I spent it at work.  I went into the office for 5 hours today!  I would say that I am at about 60-70% strength.  I was able to walk 3 times a day for 20 minutes each of the last 7 days, and probably could have done more without too much issue. I’m thrilled to have been able to do the less invasive procedure, and know that my recovery has been improved because of it.

My surgeon was Dr. Narendra Sastry in Tampa, Florida. He was excellent at describing the procedure and his bedside manner was fantastic.  I am lucky to have found him.

Let me know if there is anything else I can share.  One thing worth noting… The only reason I qualified to do the surgery in this manner is because I ONLY had the aortic valve replaced.  If any other procedure is required at the same time, then the minimally invasive option is not an option.

In closing, thank you for writing your heart valve book and starting this website.

Jim Engelmann
Clearwater, FL

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

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  • dena

    I am planning of having a minimally invassive AVR in about a month, I found a great dr in NY, I looked in Tampa and id not find one, interesting to know. Did your surgen suggested for you to have the mechanicale alve or was it your choice. My surgeon in NY suggesting a tissue valve.

    Thak you for sharing this story, scarry.
    dena

  • Don Henry

    Hi Jim,

    Congratulations on your successful surgery. I think this is truly awesome.
    May I ask your age? And why did the surgery take 7.5 hours? I can’t say enough about the advances in heart surgery. I had my aorta replaced at age 55 with a Carpentier Edwards bovine valve 9 years ago and I am doing well. I will need to have this surgery again and I am hoping to have the mini-thorocotomy technique unless even something better comes along. This is great news and something positive for people , who will be facing this surgery.

  • Tammy

    My Dad needs aortic valve replacement surgery. He is 67 y.o. and has a bicuspid aortic valve. We will be discussing with the surgeon less invasive techniques such as the mini-thorocotomy. The hospital in NY we are going to also does minimally invasive port access valve replacements. I am not sure if he will be a candidate for this. I wanted to inquire about anyone who may have had this type of procedure done. Is this more commonly done with mitral valve than the aortic valve? I appreciate any feedback.

    Thank you, Tammy

  • Kathy Lemons

    The thoughts of a less invasive procedure for aorta valve replacement sounds wonderful. Can the less invasive procedure be done with either the mechanical valve or the bioprosthetic valve? Obviously, from your comments, the Ross procedure would not qualify for this procedure but I was curious about the other valve replacement options.

  • fazilat

    hi i am so pleased to hear about the minimal invasive procedure i am not sure if this is available in uk but it will be great as the breaking of the sternum is very hard to recover from, i am post op 10 months now thank god one question though is this procedure also for women as we have breasts, how would they gain entry to the heart.
    thank you. fazilat

  • jim engelmann

    Sorry that I wasn’t able to respond to the questions earlier. As I know that there are probably others with some of the same questions, I thought that the answers would still be relevant.

    I was 42 at the time of my surgery. My surgeon recommended a mechanical valve so that it would last as long as possible. (Pig and cow valves have a shorter life than mechanical). However, the surgery can be performed with either. My surgery took so long because it was the first time my surgeon had performed it, and he was taking each step slowly. As for women, it’s actually a better procedure, taking place above the breast. It avoids scarring the clevage.

    As for my recovery…

    It took longer than I expected to be at 100%. I believe this has to do with all of the medications. I found myself tired, forgetful and weak. Once I was off (yes, OFF) of all of the blood pressure medication I really recovered quickly. Right now I am only on coumadin and lipitor. I felt like I was at 100% after about 8 months. I’m not sure that everyone can get off of the medications, but I know that it was key to my full recovery.

    If any of you are researching options, this is certainly one worth investigating fully.

    Jim

  • Joseph

    To all:

    We have read about the different valves that are available to heart patients. Bovine, Porcine, Mechanical.

    But has anyone ever heard of a HORSE valve for Aortic valve replacement?

    Thank you for anyone whom answers this e-mail,

    Joseph at Camelot47@aol.com

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