Wayne's Posts

2nd opinion for sure with someone who does a lot of minimally invasive. I was of the opinion and could of course be wrong that surgeons either did one or the other or leaned toward one or the other. Maybe throwing in the tricuspid is the reason. Need more room to maneuver.

Welcome to my summer 2023 ! I toiled over this decision - and was very data driven in the methodology. There are clear tradeoffs on both options - and ultimately you will need to pick your poison - as I did ! One point - the minimally invasive surgeons do tend to downplay potential negative aspects - happy to discuss this with you.... Good luck man !

Wayne - I echo the advice you've already received about a second opinion. I spoke to a very respected full-robotic mitral valve surgeon who told me that he sometimes recommends sternotomies (his words) 'when we want to get in and get out. In a month, it won't matter how it was done.' Sternotomy and mini-sternotomy are the fastest way to access and repair the heart. Less anesthesia and less time on bypass are big positives. An experienced minimally-invasive surgeon will tell you if you aren't a good candidate for that entry. You want the best repair - everything else is way down on the priority list. I would choose a minimally-invasive procedure again, but everyone needs to make the choice that's right for them. ❤️

Everyone is different but my robotic mitral valve repair did not work from day 1. I subsequently had open heart surgery elsewhere and they found the tricuspid valve also needed repair. I do not know why the robotic surgeon did not see that. Maybe it is easier to identify unexpected issues during open heart surgery?

I was told the "minimally invasive" procedure through the ribs is higher risk and that its only plus side is the shorter recovery time. You have more nerves between your ribs so it's more painful. Surgeon has to maneuver around many obstacles, so there are more chances of complications and it takes longer, which means you are on the bypass machine longer. For me, the most important thing was to limit the time I was on the machine. You may have other priorities. You should definitely get a second opinion, but as others already pointed out, each surgeon has their preferred method, so you may need to get more than two opinions if you are not quite set on which method YOU prefer.

Consider yourself lucky that yr surgeon suggests reinforcing the tricuspid when working on the mitral. Not all do this and patients end up needing a 2nd surgery for the tricuspid as mitral work can affect the tricuspid later. Trust yr surgeon as he/she made a good decision for you. Minimally invasive is not always the best choice. You can always ask for what you want but that does not mean it's a better choice.

Hi Wayne, a second opinion is always a good option. I had my mitral valve and tricuspid valve repaired by Dr. Gillinov at Cleveland clinic this past April. I had hoped for the minimally invasive surgery, but ended up with a full sternotomy. All things considered I had a great recovery.

I just met with my surgeon a week ago yesterday. We had that same discussion. He indicated to me that he felt that he could see things better through direct observation rather than from a camera. I work in the Broadcast Television industry and I can appreciate that perspective. He said that it would also allow him to see if there is anything else that needs attention while he is in there and that could avoid another surgery later on. I believe they are valid points. He also made my wife and I very comfortable, which to me is a very important thing. He did say that he would do a mini Sternotomy which would be considerably less traumatic than a full Sternotomy. He also said that I have very few additional risk factors. If I were a smoker, drinker, in poor health etc, the minimally invasive surgery would be more appropriate.

Gary - That's interesting that your surgeon said that minimally-invasive entries are for higher risk patients. That may be true for transcatheter-aortic valve replacement, but quite the opposite for minimally-invasive mitral valve repairs. They actually require more scrutiny before they can be approved - including a CT scan with contrast of the chest, abdomen, and pelvis since the bypass line is placed in the femoral artery. Also, If any additional heart procedures or anomalies are revealed in the pre-op tests, this form of entry denied. It sounds like your surgeon has his own preferred method of entry or never perfected the mini-thoracotomy. Marie is absolutely right (see her comment above). You still have time to speak to a minimally-invasive mitral valve surgeon if you want another opinion. The entry isn't the most important thing, but it is generally a factor in the length of the hospital stay and can shorten the recovery time. Get the best repair you can and be your best advocate. ❤️