Resting HR post-AVR surgery

HokieHaden · Dec 1, 2023

Hi all - I'm 49 and 5 weeks post AVR and aortic aneurysm replacement (Bentall procedure) surgery and recovering well. Prior to surgery, I was in strong cardiovascular shape, primarily as a recreational road cyclist. I rode 25 miles two days before surgery and had ridden over 100 miles in a MS Society fundraiser weekend ride just two weeks prior. Anyway, point is, my resting heart rate was consistently in the low 60s prior to surgery. Professional athletes have a resting HR in the 40-60 range, so I wasn't at that level, but still....in good shape. Since surgery, I've noticed a much higher resting HR. I've been monitoring resting heart rate and it's been in the upper 70s since surgery. So, I've gone from a pre-surgery average around 61 to post-surgery around 76. When I asked my surgeon and NP about this, they assured me it was a normal change due to my surgery and the heart reacting to that trauma. Fair enough, but....the NP said, "it will come down, but it may never get back down to your pre-surgery level".

She didn't offer an explanation for that statement, so I'm curious if others here have experience or know - is it possible I will simply never get back into the same cardiovascular shape I was in pre-surgery? If so, I'm curious why. In my simple mind, I've gone from an extremely leaky and inefficient native bi-cuspid valve to a very efficient (albeit bio-prosthetic) aortic valve and root. As such, I was actually reasoning I might even see improved cardiovascular performance. Thanks!

Chuck C · Dec 1, 2023

Glad to hear that you're recovering well!

HokieHade said:
So, I've gone from a pre-surgery average around 61 to post-surgery around 76.

HokieHade said:
so I'm curious if others here have experience or know - is it possible I will simply never get back into the same cardiovascular shape I was in pre-surgery?

Having an elevated heart rate after surgery is normal. My experience was similar to yours. My resting HR was in the mid to high 50s prior to surgery. The elevated rate was partially masked from being on metoprolol for a couple of months, but once I went off it, it went to the mid 70s, as I recall. It gradually came down over the course of about a year. Now, 32 months out, it is typically between 60 and 65.

HokieHade said:
is it possible I will simply never get back into the same cardiovascular shape I was in pre-surgery?

I think that you probably can get back there. I currently am doing about 60 to 90 minutes of cardio per day on the treadmill and I seem to be able to go at about the same level as pre-surgery. I also have done a lot of jiu jitsu and some boxing, which both really test the cardio. It is hard to know for sure if I am at the same level as before, as I don't push myself 100% now, to avoid putting too much pressure on my new parts, but I would estimate that my level is very close to what it was. Also, it seemed that I was seeing improvement in my cardio for over 2 years post surgery, so it might take a long time to know if you will get back to 100% to where you were at prior.

HokieHaden · Dec 1, 2023

Chuck C said:
Glad to hear that you're recovering well!

Having an elevated heart rate after surgery is normal. My experience was similar to yours. My resting HR was in the mid to high 50s prior to surgery. The elevated rate was partially masked from being on metoprolol for a couple of months, but once I went off it, it went to the mid 70s, as I recall. It gradually came down over the course of about a year. Now, 32 months out, it is typically between 60 and 65.

I think that you probably can get back there. I currently am doing about 60 to 90 minutes of cardio per day on the treadmill and I seem to be able to go at about the same level as pre-surgery. I also have done a lot of jiu jitsu and some boxing, which both really test the cardio. It is hard to know for sure if I am at the same level as before, as I don't push myself 100% now, to avoid putting too much pressure on my new parts, but I would estimate that my level is very close to what it was. Also, it seemed that I was seeing improvement in my cardio for over 2 years post surgery, so it might take a long time to know if you will get back to 100% to where you were at prior.

Very helpful, Chuck - thanks for sharing your experience and insights!

Woodcutter · Dec 1, 2023

HokieHade said:
Fair enough, but....the NP said, "it will come down, but it may never get back down to your pre-surgery level".

My experience has been that my resting heart rate increased about 10 bpm.

Some differences (my situation vs yours!). Mine is in the mitral position. I have a mechanical valve. I required 2 surgeries. I've had some arrythmias.

Similarities: I was 50. Pretty fit. Lifelong endurance athlete.

I went in to my surgery with a RHR in the mid-40's. Today it's mid-50's. I distinctly recall paying a lot of attention to my heart rate for at least a year. When I did my first half-marathon about 10 mos. out my RHR was in the low 60's. So it was still 'settling' for a good year or two.

As far as cardiac output is concerned, the surgery impacts several fundamental things. The body just wants flow. I like to think of this as Heart Rate X Swept Volume minus (leakage + regurgitation ) [each beat]. The surgery almost certainly improved the leakage and/or regurgitation but with tissue swelling, physical size changes at/around the valve, and disturbing electrical pathways there are actually quite a few 'moving parts' that directly and indirectly impact the rate and volume.

So I believe you will continue to see improvement for many months.

HokieHaden · Dec 1, 2023

Woodcutter said:
My experience has been that my resting heart rate increased about 10 bpm.

Some differences (my situation vs yours!). Mine is in the mitral position. I have a mechanical valve. I required 2 surgeries. I've had some arrythmias.

Similarities: I was 50. Pretty fit. Lifelong endurance athlete.

I went in to my surgery with a RHR in the mid-40's. Today it's mid-50's. I distinctly recall paying a lot of attention to my heart rate for at least a year. When I did my first half-marathon about 10 mos. out my RHR was in the low 60's. So it was still 'settling' for a good year or two.

As far as cardiac output is concerned, the surgery impacts several fundamental things. The body just wants flow. I like to think of this as Heart Rate X Swept Volume minus (leakage + regurgitation ) [each beat]. The surgery almost certainly improved the leakage and/or regurgitation but with tissue swelling, physical size changes at/around the valve, and disturbing electrical pathways there are actually quite a few 'moving parts' that directly and indirectly impact the rate and volume.

So I believe you will continue to see improvement for many months.

Thanks so much, Woodcutter. First off, wow....your resting was in the 40s before surgery!? Good to hear your experience and that you've largely returned to pre-surgery levels of fitness. I do expect it will be a long process of recovery and getting back to "normal". While I lack the patience for that "marathon", I appreciate hearing the truth. And, thank you for the thoughts on the many different factors impacting flow. That all makes sense. Thanks again!

pellicle · Dec 1, 2023

I don't have a clear recollection of my resting HR in 1974 nor 1992, but in 2012 it was elevated for some time and had bouts of elevated (over 100) even while on metoprolol for some months. I can't be sure (because I wasn't documenting such things) but by 4 or 5 months post-op I was back to normal.

Interestingly during my bouts of elevated HR I found that breating in as deep (deep ... like holding your breath world record attempt deep) and holding it (which my previous years of snorkelling assisted with) would on perhaps the first hold, or the follow up hold, bring my HR in the space of "the next beat" back into about 60bpm.

Interestingly this still works but as you may know I've been back on Metorprolol for about a year now (it'll be two in 6 months).

HTH

treichert0312 · Dec 2, 2023

This last surgery was #3 - similar to you I was in good shape going into it - great way to get new parts. Makes the healing better - still not easy.
1-1/2 years out - I feel great but my times are slower. Is it the heart or my age? 55 yo now.
Apple Watch tells me RHR = 54 but that does include a lot of sleeping last night.
At the rehab 3 months out, I took my hr above 150 on the elliptical b/c I was feeling great! Until the nurses took me off it and told me to chill out.

I still crank my rate up once in awhile when running but it comes back down soon. This is 1-1/2 years after getting the On-X.
That’s just my experience- I’m thinking your sternum is still healing 5 weeks out. Give it 6 months & I bet the rate drops more.

V__ · Dec 2, 2023

HokieHade said:
5 weeks post AVR ...my resting heart rate was consistently in the low 60s prior to surgery. ... I've been monitoring resting heart rate and it's been in the upper 70s since surgery.

Just 2 comments. I had MVr, for which it's known that the heart adaptation after the surgery ("reverse remodeling") takes many months. Studies see signs of changes a year later, although the initial changes are fast (weeks). Don't know about AVR, but would not be too surprised if there is a long-term adaptation present as well.

Just checked my Fitbit records. The accuracy is not great, but perhaps it's indicative. There was a similar effect after surgery. At some point rest HR got down to almost the previous level. My guess is that the exercise capacity eventually got high enough to reduce HR. Your capacity seems to be quite high already, so perhaps you'll see HR reduction sooner.
May:22: 58
Jun'22: 57
Jul'22: 58
Aug'22: 58
Sep'22: 59
Oct'22: surgery
Nov'22: 62
Dec'22: 66
Jan'23: 66
Feb'23: 67
Mar'23: 68
Apr'23: 67
May'23: 65
Jun'23: 66
Jul'23: 64
Aug'23: 62
Sep'23: 61
Oct'23: 60
Nov'23: 61

pellicle · Dec 3, 2023

V__ said:
. At some point rest HR got down to almost the previous level.

nice work mate, deserved a graph

Surgery is the missing data point and the trend line is 2 week moving average "centered"

Best Wishes

d333gs · Dec 3, 2023

Hi Hokie, before surgery I was low 50s and in the 40s when sleeping. After surgery ,it took a couple of weeks to stabilize from very low (32) to a resting high of 100. Then , for the first year, the resting average was high 60s to high 70s. Now 22months after surgery I am 56 as I type and 46 as I slept last night . So it takes time I guess. When you think about it , the sudden change in valve size must be a big surprise to the heart , and it takes time to adjust. It is a big change in necessary pump pressure.

SSJ4 · Dec 8, 2023

HokieHade said:
Hi all - I'm 49 and 5 weeks post AVR and aortic aneurysm replacement (Bentall procedure) surgery and recovering well. Prior to surgery, I was in strong cardiovascular shape, primarily as a recreational road cyclist. I rode 25 miles two days before surgery and had ridden over 100 miles in a MS Society fundraiser weekend ride just two weeks prior. Anyway, point is, my resting heart rate was consistently in the low 60s prior to surgery. Professional athletes have a resting HR in the 40-60 range, so I wasn't at that level, but still....in good shape. Since surgery, I've noticed a much higher resting HR. I've been monitoring resting heart rate and it's been in the upper 70s since surgery. So, I've gone from a pre-surgery average around 61 to post-surgery around 76. When I asked my surgeon and NP about this, they assured me it was a normal change due to my surgery and the heart reacting to that trauma. Fair enough, but....the NP said, "it will come down, but it may never get back down to your pre-surgery level".

She didn't offer an explanation for that statement, so I'm curious if others here have experience or know - is it possible I will simply never get back into the same cardiovascular shape I was in pre-surgery? If so, I'm curious why. In my simple mind, I've gone from an extremely leaky and inefficient native bi-cuspid valve to a very efficient (albeit bio-prosthetic) aortic valve and root. As such, I was actually reasoning I might even see improved cardiovascular performance. Thanks!

Haden,
I have been following your posts since your surgery. I responded to one of your pre-surgery posts several months back as I was scheduled for the exact same procedure at Shands at the University of Florida just one day prior to your surgery and we are very close in age. I found that I needed to step away from reading these boards prior to the surgery but reading them post surgery to hear other's recovery experiences has been helpful. It sounds like you are doing well. Glad to hear that. My surgery, hospital stay and post surgery experiences have been amazingly similar to yours. This has been quite an experience but recovery has been going well. It is a great feeling to have it behind me and look forward to feeling completely back to normal whenever that occurs.

HokieHaden · Dec 8, 2023

Great to hear from you, SSJ4! Glad to hear your surgery went well and that you're recovering well too. Best!

V__ · Dec 10, 2023

pellicle said:
nice work mate, deserved a graph
View attachment 889704
Surgery is the missing data point and the trend line is 2 week moving average "centered"

Best Wishes

Thanks for plotting! Indeed, graph is a much better representation, I was just in a rush. In principle, the trend could look more clear, but life interfered:

November'22 jump seems subdued, but maybe it was due to amiodarone that month.
Some other months (March, June, November'23) have slight bumps that are due to overseas travel and jetlag. These things (or lack of sleep in general) always increase HR.

Al3x · Dec 10, 2023

I had a similar experience. Pre surgery RHR was 45. Immediately post surgery it was in the high 70s, which felt to me like it was racing even though it's within the normal range. 28 months later and I'm back down to 50.

As for performance, I'm doubtful if I will get completely back to where I was. My Half Marathon time 6 months before surgery was 1:22. I have done two since surgery. 1:37 seven months after, and 1:30 nineteen months after. My next is in March and I will be aiming for 1:27. I'm no longer near the front of the pack but I can still beat most of my mates!

I would say that my short distance performance has declined much more. 5km times have gone from 16:30 to 19:00.

Good luck with your recovery. Don't push it, but there's improvement left in you!

Timmay · Dec 10, 2023

FWIW, same here. Resting heart rate is between 10-15bpm higher now than before surgery (year and a half ago)

Chuck C · Dec 10, 2023

Chuck C said:
My resting HR was in the mid to high 50s prior to surgery. The elevated rate was partially masked from being on metoprolol for a couple of months, but once I went off it, it went to the mid 70s, as I recall. It gradually came down over the course of about a year. Now, 32 months out, it is typically between 60 and 65.

I thought I should update this comment that I made a few days ago. The last two days I checked my morning resting pulse, after I had been awake for a few hours. So, not my sleeping pulse, but what I would call my morning resting pulse rate. My morning resting pulse was 58 and 57 respectively. So, that's lower than the 60 to 65 range I was seeing a few months ago and per my comment above. I thought it had bottomed out, but perhaps not, at least based on the readings from the past two days. This would represent a return to about the resting HR I was at prior to surgery. I'm 33 months out from my aortic valve replacement.

I'm pleasantly surprised and will be looking closely to see if it stays in this range. I did 13 rouds of boxing yesterday and felt pretty amazing- probably about the same as how I would feel when sparring prior to surgery, despite being almost 3 years older now.

Of course, that is just my data, but it would suggest that the resting pulse may continue to normalize for some time after surgery, maybe even a few years after surgery. I should also note that I did elect to get my surgery done prior to the onset of symptoms and that could be a factor.

Survived03 · Dec 10, 2023

Hokie hade, I am a little over 6 months post surgery and my resting HR is back in the low 50’s as it was pre surgery. This is without beta blockers which for now I am no longer on (after 20 years). I do anticipate having to tweak my BP med (losartan) or add an additional med to bring it down a bit. I seemed to have landed at around 135-140’s/70 once I healed and once all the ameoderone washed out of my system. Excercise has been getting better and better too. You will get there.

Beach77 · Dec 10, 2023

My resting HR prior to surgery was in the mid 50's. It's been 3 years (12/03/2020) since my surgery and my resting HR is back to the mid 50's. It took about 1 to 1 1/2 years to get it back. I had a few challenges during my first year of recovery (my thyroid was a huge challenge). My doctor is impressed/happy with my heart rate & blood pressure! Especially since I'm in my mid-60's! I'm really happy with it too! Give yourself time for healing, you'll get there when your heart is ready!

d333gs · Dec 19, 2023

"I'm curious if others here have experience or know - is it possible I will simply never get back into the same cardiovascular shape I was in pre-surgery?"
My post-op biking times improved dramatically . 6 months after my op I felt bionic.

HokieHaden · Dec 19, 2023

d333gs said:
"I'm curious if others here have experience or know - is it possible I will simply never get back into the same cardiovascular shape I was in pre-surgery?"
My post-op biking times improved dramatically . 6 months after my op I felt bionic.

Awesome! This is what I was hoping I might hear from some. As I shared in my original post — “In my simple mind, I've gone from an extremely leaky and inefficient native bi-cuspid valve to a very efficient (albeit bio-prosthetic) aortic valve and root. As such, I was actually reasoning I might even see improved cardiovascular performance.”

Resting HR post-AVR surgery

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