9 months post-AVR and cycling at my best ever

[HokieHaden]

Hi all - I'm 49 (almost 50) and had AVR and repair of an aneurysm of the ascending aorta (together, a Bentall procedure) on Oct 25, 2023. Surgery went well and I eased back into my favorite exercise and hobby, road cycling, by 10-12 weeks post-op. I was actually on the Peloton riding at maybe 5-6 weeks out.

Anyway, the point of this update is to say that I posted here back then about whether I would ever return to (or even exceed) my level of cycling performance after surgery. I reasoned that for 49 years I had a severely leaky bicuspid aortic valve, which my body was having to compensate for when exercising. I reasoned that a new (bovine tissue, in my case) artificial valve would function better, so in time I reasoned I may exceed prior cardiovascular performance.

Well, I've been riding all year, including a 65 mile MS Society fundraiser ride in Kentucky in June. And, today I rode a 24 mile route that I had last ridden on Oct 23, 2023 - 2 days prior to surgery. I'm happy to report that my time this morning was 1 minute faster than that ride just before my surgery! Now, to be clear, I'm still a recreational rider who isn't competing or anything like that. But, I can easily see progress since surgery and I'm on a trajectory to performing at a higher level than I ever have.

I'll also note that my HR when riding has significantly changed as well. Prior to surgery, I would consistently spike up to 180-184 when really pushing it (climbing hills). Today, same hills and my HR never gets above 173 or so. And, I'm riding just as "hard" as I did before. So, that also feels like a win.

Attaching a picture for fun. This was taken at that Kentucky ride in June. I'm the guy in the Optum jersey on right.

 

[SatoriFound]

Well, I've been riding all year, including a 65 mile MS Society fundraiser ride in Kentucky in June. And, today I rode a 24 mile route that I had last ridden on Oct 23, 2023 - 2 days prior to surgery. I'm happy to report that my time this morning was 1 minute faster than that ride just before my surgery! Now, to be clear, I'm still a recreational rider who isn't competing or anything like that. But, I can easily see progress since surgery and I'm on a trajectory to performing at a higher level than I ever have.

That is so exciting! My mother had MS and it was awful, thank you for helping the cause. We do the MS walk every year as a family. We used to take her in her wheelchair, but she passed last year.

It's good to know that I may someday feel normal again, possibly better than my normal.

 

[d333gs]

Hi all - I'm 49 (almost 50) and had AVR and repair of an aneurysm of the ascending aorta (together, a Bentall procedure) on Oct 25, 2023. Surgery went well and I eased back into my favorite exercise and hobby, road cycling, by 10-12 weeks post-op. I was actually on the Peloton riding at maybe 5-6 weeks out.

Anyway, the point of this update is to say that I posted here back then about whether I would ever return to (or even exceed) my level of cycling performance after surgery. I reasoned that for 49 years I had a severely leaky bicuspid aortic valve, which my body was having to compensate for when exercising. I reasoned that a new (bovine tissue, in my case) artificial valve would function better, so in time I reasoned I may exceed prior cardiovascular performance.

Well, I've been riding all year, including a 65 mile MS Society fundraiser ride in Kentucky in June. And, today I rode a 24 mile route that I had last ridden on Oct 23, 2023 - 2 days prior to surgery. I'm happy to report that my time this morning was 1 minute faster than that ride just before my surgery! Now, to be clear, I'm still a recreational rider who isn't competing or anything like that. But, I can easily see progress since surgery and I'm on a trajectory to performing at a higher level than I ever have.

I'll also note that my HR when riding has significantly changed as well. Prior to surgery, I would consistently spike up to 180-184 when really pushing it (climbing hills). Today, same hills and my HR never gets above 173 or so. And, I'm riding just as "hard" as I did before. So, that also feels like a win.

Attaching a picture for fun. This was taken at that Kentucky ride in June. I'm the guy in the Optum jersey on right.

View attachment 890441

Wow!! Before my AVR I thought I was doing great on my "all out, try to beat the clock " 27K cross-country bike rides . Then 6 months after my ARV I was doing the same ride 16 minutes faster.....which, to say the least , left me stunned.

 

[SatoriFound]

Wow!! Before my AVR I thought I was doing great on my "all out, try to beat the clock " 27K cross-country bike rides . Then 6 months after my ARV I was doing the same ride 16 minutes faster.....which, to say the least , left me stunned.

Amazing! You didn't even realize how your heart was effecting your performance. My workouts might just go to a new level. LOL

 

[d333gs]

Amazing! You didn't even realize how your heart was effecting your performance. My workouts might just go to a new level. LOL

"My workouts might just go to a new level. LOL " Yeah! Why not!
Was there anything else wrong with you? Is the aneurysm repair fragile?
In a sense, you just got an engine rebuild! It should be able to outperform the old one.

"You didn't even realize how your heart was affecting your performance"
No I didn't realize. I had been focused on tennis and walking. When I was 63 the cardio told me to stop because of the nature of the game and its effect on the heart. So I started biking. And it got easier and faster as time went on. I honestly thought they were misdiagnosing me .
Then, when I was 68, they sent me to a large hospital in Marseille France and of course my small town Cardio was right ; I had severe stenosis and I had to stop all sporting activity.
Within a month, stairs were giving me a problem. One month later I had a new valve.

 

[SatoriFound]

"My workouts might just go to a new level. LOL " Yeah! Why not!
Was there anything else wrong with you? Is the aneurysm repair fragile?
In a sense, you just got an engine rebuild! It should be able to outperform the old one.

"You didn't even realize how your heart was affecting your performance"
No I didn't realize. I had been focused on tennis and walking. When I was 63 the cardio told me to stop because of the nature of the game and its effect on the heart. So I started biking. And it got easier and faster as time went on. I honestly thought they were misdiagnosing me .
Then, when I was 68, they sent me to a large hospital in Marseille France and of course my small town Cardio was right ; I had severe stenosis and I had to stop all sporting activity.
Within a month, stairs were giving me a problem. One month later I had a new valve.

Dang! Yeah, my appointment to discuss my test results with my cardio is still a month away. The office said the doctor didn't think it was an emergency and could wait. My aortic aneurysm measures 4.5 which is normally a watch and wait thing, but they think I have a bicuspid valve, but neither the echo nor the CT could verify due to heart positioning in my chest. I have asymmetric septal hypertrophy, a mildly dilated left atrium, my aortic stenosis went from moderate to severe in 18 months with significant changes in my numbers, plus I am having more days with symptoms other than just the constant fatigue. The aneurysm was found when they ordered a follow up CT to the echo. I am only 50 so it would be nice to have some energy again. I am a little surprised that with the aneurysm measurement he didn't order a TEE to try to get a definitive answer to the bicuspid valve issue. Maybe he is just bringing me in to explain my results and refer me out to a surgeon? From what I read the 4.5 measurement coupled with bicuspid valve usually involves a recommendation for surgery, whereas without the bicuspid valve it is 5.5. It's hard waiting on the actual doctors opinion and everything I know about my test results is from Dr. Google (my wife). It's crazy one day I knew I had a lifelong heart murmur and the next the doctor was telling me I had aortic stenosis. It just isn't something you expect to hear at 48 years old.

 

[d333gs]

A section of the bike trail I use, plus my prehistoric mountain bike

 

[d333gs]

Two years 7 months after my AVR , I just made a new best time on my bike.
Am I bragging? Yes! But also , for those who are wondering if you can reclaim your level of fitness after your OHS , it seems like you can.
Yesterday was hot here 35c . So I did the shorter version of my bike ride which is 23k with good hills. Last year, my max , all out , verge of exploding best time was 1 hour 11 minutes.
Yesterday I did it in 1 hour 7 minutes, 4 minutes faster.
This is slow for a road bike but for an old mountain bike , it is not bad.

 

[skier]

I'll also note that my HR when riding has significantly changed as well. Prior to surgery, I would consistently spike up to 180-184 when really pushing it (climbing hills). Today, same hills and my HR never gets above 173 or so. And, I'm riding just as "hard" as I did before. So, that also feels like a win.

Are you on a beta blocker? A beta blocker will lower your heart rate at the same level of effort. At least, metoprolol does for me.

I'm also a cyclist and use a power meter. When I'm on metoprolol, my heart rate is 10 - 20 beats/min lower at the same power output. I have no idea how my body does that. Very strange.

 

[HokieHaden]

Are you on a beta blocker? A beta blocker will lower your heart rate at the same level of effort. At least, metoprolol does for me.

I'm also a cyclist and use a power meter. When I'm on metoprolol, my heart rate is 10 - 20 beats/min lower at the same power output. I have no idea how my body does that. Very strange.

No beta blocker

 

[skier]

No beta blocker

Nice. Then, no doubt you are fitter.

Do you have a wearable that estimates VO2 max? I wonder if your estimated V02 max increased.

FYI, I did a medical VO2 max test after my surgery to clear me for high-intensity exercise. The accurate laboratory result wasn't far off my Garmin's estimate. As I've become fitter, it's been nice to see the Garmin estimate go up slightly. I now have a goal of trying to increase the VO2 max estimate for both running and biking.

 

[d333gs]

What is you VO2 max at now? I have one on my watch but it does not work with biking.

 

[skier]

What is you VO2 max at now? I have one on my watch but it does not work with biking.

My watch needs a power meter on the bike to calculate VO2 max, so maybe that's why yours is not working. It may also require a chest strap instead of the wrist-based HR. I think mine does.

These are the latest estimates from Garmin for my running and biking VO2 max:

Cycling:

Running:

I hope to keep slowly improving my VO2 max as I train and improve my fitness.

My cycling VO2 max measured at the cardiac lab last year was 39, while Garmin said it was 40. I was surprised by how close they were.

A few notes about the VO2 max test in the lab:

I chose the bike test over the treadmill because I was in better cycling condition. That was a big mistake, as the exercise bike in the lab was terrible. There was no way to make it fit well. Worst of all, they need you to maintain a cadence of 50 rpm seated! My regular cadence is a typical 85-90 rpm, so my legs hated it. I had to stop due to leg pain rather than max out cardiac output as desired.

It was still a very useful test, as I got my heart rate up to 171 vs. maybe 175ish if I was on my own bike. The benefit is that they are watching your ECG, taking your blood pressure, and precisely monitoring your breathing throughout the test as your heart rate and workload increase. It's comforting to know that everything is working well in the lab so that I can push it outside. This is the key note from the sports cardiologist following the test:

We did discuss limiting his HR such that he is not exercising at excessively high HR, greater than 150-160bpm for a prolonged period of time, but I do not see any risk with short-term (several minutes) increases in HR.​

 

[d333gs]

Interesting! A sport cardio sounds like a good idea. I will look into that possibility as well as a Garmin setup. My VO2 Max changes with each hard walk ; the Last walk was 42,9..The cardio recovery is always 33 , so I suspect it is not working.
Since I have had a watch I have never had a heart rate over 150 that did not look like an Apple Watch error.
Before my AVR my peak heart rate was in the low 150s . Now 142 is rare and my resting heart rate can be as low as 46. Sometimes I get high heart beat spikes but I think they are errors. I can't imagine getting up to 175 like you! I also watch METs which measure physical effort.
Thanks for responding , this is all really interesting stuff.

 

[treichert0312]

I’m using Strava to check my speed. Went to a gravel bike and increased speed by going from 650x32 to 700x25. . But the exciting thing has been getting the daily plank going, and consistently getting faster on Drill Hill 7.5% grade. In Ohio, so not a long hill, but knocking that time down & getting faster is satisfying. Seems maybe more my technique and less the valve.

 

[d333gs]

I’m using Strava to check my speed. Went to a gravel bike and increased speed by going from 650x32 to 700x25. . But the exciting thing has been getting the daily plank going, and consistently getting faster on Drill Hill 7.5% grade. In Ohio, so not a long hill, but knocking that time down & getting faster is satisfying. Seems maybe more my technique and less the valve.

Kool! I have run of the mill 26" X 2.25 tiers . I have a soft tail.......So when I am pumping up a hill , the first thing that happens before I get movement is that my rear end descends!!