New valve replacement option: less pain, shorter hospital stay

When doctors and surgeons in the Heart and Vascular Center at University of Iowa Hospitals & Clinics learned there was a new way to perform an aortic valve replacement that resulted in less pain and shorter recovery times for patients, they knew it was something they wanted to investigate further and bring to their patients.

The primary technique for completing a replacement had been a median sternotomy, involving a vertical incision along the sternum and the cutting through the breast bone to access the valve.

This traditional procedure has a six- to eight-week recovery period, during which time patients are often limited in their activity levels.

Going between the ribs

A handful of surgeons across the country started doing a mini-thoracotomy approach, which involves going between the ribs and accessing the valve without cutting any bone.

“Recovery is much faster and their activity restrictions are lessened,” says Jay Bhama, MD, former chief of adult cardiac surgery at UI Hospitals & Clinics. “The patients can get up and around much sooner after surgery.”

Led by Mohammad Bashir, MD, also an adult cardiothoracic surgeon at UI Hospitals & Clinics, the Heart and Vascular Center became interested in the minimally invasive procedure in 2017 and began working to offer the procedure at UI Hospitals & Clinics. Once the necessary equipment was in place, the center was able to offer the procedure in early 2018.

Golfing again soon after surgery

For Tim McClimon of DeWitt, having the option of less pain and faster recovery was “a no-brainer.”

“My recovery was faster, and I haven’t really needed much pain medication,” he says. “My surgery was on a Monday, and by Wednesday afternoon I was able to stop taking the pain medications.”

Though he was still under some lifting restrictions for about six weeks, McClimon says he was able to surprise a friend on the golf course just two weeks after his surgery.

“He’d had one of the other procedures a few years ago and wasn’t able to do anything for weeks,” McClimon says. “He told me he didn’t think he’d be seeing me for a while.”

Bhama says only about a small percentage of hospitals across the country are offering the mini thoracotomy, and UI Hospitals & Clinics is one of the first in Iowa to offer it.