Open Heart Surgery

My 100 hour Mitral Valve Repair

(Part 3: Recovery)

Returning home... Not what I imagined

Never having had major surgery before and being unable to find much in the way of firsthand information on the recovery process, I imagined the worst. I assumed I'd be bedridden for weeks if not months. Accordingly I put an Internet connection in the bedroom so that I could check my Email and surf the web from bed, set up a remote control for the satellite receiver and VCR in the other room, a reading light, a bell to call my wife when I didn't have the strength to speak, and a stack of books and magazines that I never seemed to have time to read. In the living room I set out a comfortable chair in front of the TV. I figured that once I had the strength to drag myself out of bed I'd veg out on Soap's, the Cooking Channel, and other daytime fare.

I couldn't have been more wrong...

While it had only been a few days, it felt like I'd been away for a very long time. Not only that, it felt like beginning a new chapter of life... a new beginning; I felt fantastic! Superman had nothing on me. I felt like I could do anything I wanted. I didn't collapse in bed, or veg out in front of the TV, instead I simply picked up where I left off and went about doing the chores that had stacked up while I was in the hospital. In retrospect, this was probably very unwise.

I was told at the hospital that I shouldn't drive for four weeks after the surgery. No one told me why, but I was assuming it was because of the stress that would be put on the sternum if I was in an accident. I had a image in my mind of those tests where a car slams into a cement block and the crash dummy crumbles in a heap. Well that may be, but I discovered the hard way that there was another problem. The first time I drove, I got pinned into a parking space by a large truck. To get out I had to crank the wheel lock-to-lock repeatedly. After doing this a couple of times I heard a pop in my chest and felt a sharp pain. I learned later that the two halves of my sternum separated and moved.

Another restriction was on the amount of weight I could lift for the six weeks following the surgery. One person told me not to lift over five pounds, another said ten pounds. Either way it wasn't much.

Lastly, I was told that for the rest of my life I'd have to take antibiotics when I had any "below the gum" dental work done; this includes routine dental cleanings. Apparently this is just a safety precaution to protect the valve from possible infection. No big deal since I, like most MVP (Mitral Valve Prolapse) patients have been doing this for years.

I thought you might be interested in seeing what the incisions looked like when I first got home, and what they look like now, some four months later.

The March 10th picture was taken as soon as I returned home after leaving the hospital. The long (about 4") red line is where the main incision was made. I had what is called a "minimally invasive" Sternotomy; the sternum was only cut half way down. A normal Sternotomy would involved cutting the full length of the sternum and having an incision approximately twice the length. The two smaller red lines you see (one just under the right breast and the other below the Sternotomy incision) are where the drain tubes were inserted and the lines on either side of my neck are where the catheters were located. The patches of red are where the adhesive tape was that held the wires, tubes, etc. in place.

The bottom picture is what I look like now. As you can see, the incisions are barely visible. The surgeon tells me that eventually only fine white lines will remain at the incision sites. At my age it is of no consequence one way or another, but, for those of you that worry about such things, as you can see, it is no big deal. Certainly not what I pictured in my mind prior to the surgery.

The size and location of the incision apparently depends on several variables such as the patient's gender, anatomy, and the nature of the surgery that will be performed. I know the surgeon had to see my X-ray's prior to deciding if the minimally invasive approach was applicable in my case. I've read that women are sometimes given the option of having the incision made under the breast to make it less visible. The important thing I want to get across here is there are usually options. Some approaches may have less scaring, but take longer hospital stays or healing times. Be sure to discuss this with your surgeon and decide what is best for you.

Now the downside...

One morning, approximately two months after the surgery, I felt my heart racing (my pulse was almost 200) and I felt lousy. Having been in AFib before, I had a pretty good idea what was happening. The strange thing was that I had been out of AFib for over two years prior to the surgery. I guess it could have been a coincidence, but I have a suspicion it was caused by the surgery or the onset of Dressler's Syndrome (acute pericarditis).

Dressler's Syndrome, which is an inflammation of the pericardium (the sack around the heart), is a late complication of cardiac surgery (postpericardiotomy). It is reasonably rare (4 cases out of 100,000) and can manifest itself months after the surgery. From what I've read it appears that it is usually a fairly benign condition that can be treated with an over-the-counter anti-inflammatory such as Motrin. In my case however, it was quite severe. I lost over 15 pounds in one week. I no appetite what so ever and what little I did eat came right back up. I was so weak I could barely stand.

Fortunately my cardiologist recognized the symptoms and started me on a seven-week regiment of Prednisone (an oral steroid). Within days I stated feeling better, was able to eat (and keep down) more and more food, and felt my strength start to return. By the fifth week I was feeling great. Prednisone had some rather nasty side-effects, but it did the job and that's what matters in the end.

It is now a month later. I've put back all the weight I lost, and then some. I'm still in AFib and plan to go in for Cardioversion just as soon as the cardiologist thinks it is appropriate. I'm doing OK, but not great. The post-surgery and post-Dressler's adrenaline induced euphoria have long since passed. I can't say I feel all that great, but my strength has returned and I am able to most of the things I did prior to the surgery. I can feel the sternum move and hear the occasional pop, but no pain. I just watch what and how I lift, push, etc. and take care not to overdue it.

Update: 4-13-03 (just over a year after the surgery)...

A couple of months ago I underwent another Cardioversion and, at least for now, my heart is back in normal sinus rhythm. The cardiologist has listened to my heart and taken echocardiograms and says there isn't the slightest hint of prolapse, leakage, or regurgitation; i.e. the surgery to repair my ailing valve seems to have been 100% successful.

On the down side, my sternum never healed or knitted. The surgeon thought the problem was with the lateral cut (shown in the picture as a dotted red line) and said this sometimes happens. To this day I don't know if the break was caused by something I did before it was completely healed, or it is a risk associated with the minimally invasive surgical technique; i.e. if the surgeon had cut the sternum the full length would my chances of it healing been better or worse?

I still feel rather lousy, with milder versions of the same symptoms I had with Dressler's Syndrome. I don't sleep very well, waking up several times a night soaked from night sweats. My immune system seems somewhat compromised in that I seem to catch cold much more often and more severely than I did before all this started. If all this isn't enough, the medication I'm taking to keep me out of AFib has slowed my heart rate down so slow that standing after sitting for a while is a major endeavor.

Of course the big question is: "Is it all worth it? Would you do it again knowing what you know now?" Considering the alternative is eventual heart failure, it's a no-brainer; yes, I'd do it again in a heartbeat (no pun intended).

"If I did have to do it over again, would I do anything differently?" Yes, without a doubt. For one thing, I'd ask more questions. When I asked for "minimally invasive surgery, I was picturing some sort of laproscopic technique. What I got was half my sternum cut instead of all of it. Obviously I didn't ask enough questions; didn't review the pro's and con's of my treatment options. I'd also take a lot better care of myself the next time around. I wouldn't drive until given the all-clear by both the surgeon and cardiologist. I'd keep in mind that I wasn't Superman, I'd just had major surgery, and that I'd have to give my body a chance to heal, like it or not. "Would any of this really made a difference?"... who knows? At least it would seem to be the prudent thing to do. As the old saying goes, hindsight is always 20/20.