Competitive swimming with a mechanical aortic valve ...

[JimCA]

I'm weeks away from surgery for my bicuspid aortic valve and enlarged ascending aorta. I swam competitively in high school and college and, 40 years later, I was competing in masters swimming at a pretty high level as recently as a few months ago when my cardiologist told me to stop the swimming (my aorta measuring at 5.2 cm). My hope is to live a long time, so I'm electing to get a mechanical valve, and my hospital (Cedars-Sinai) seems to favor valves from St. Jude.

Can anyone offer insights into whether it's likely I will be able to continue to swim fast, with the mechanical valve?

I prefer to race the "long sprints" - 100-meter and 200-meter swims - that last from a minute to up to three minutes, and that push the heart well into the anaerobic zone. In contrast, the long-distance runs - 5K up to a marathon - tend to be purely aerobic, and tend to be run at a much lower heart rate. More specifically, in competition my pulse might run over 170 and during workouts I tend to maintain a pulse of 120 to 155 beats per minute. I'm over 60 years old, so obviously I don't have the pulse that I had in college, when I'd push past 200 beats per minute during workouts.

Can a person with an mechanical valve achieve those kinds of heart rates? I assume I would be taking an anti-coagulant, but even then, would I be at heightened risk for thormbosis or other ailments that result from undue turbulence in the aorta?

Before I agree to a St. Jude mechanical valve, is there anything I should ask or know?

Finally, does anyone have experience with these kinds of high heart rates while "wearing" a mechanical valve?

Thanks ... Jim L

 

[Duffey]

If you've been able to maintain your rigorous swimming regime up until a few months ago, then you should have no problems post-op.
I swam a mile, sometimes two, for 20 years prior to my avr. Although it took longer to get back in the water, and regain my chest and shoulder mobility, my endurance and speed were the same, if not better.
I don't think your valve choice will impact your workouts.
Good luck!:smile2:

 

[JimCA]

Thanks, Duffy, and that's reassuring.

My concern is with the mechanical valve, and whether that will safely allow the high pulse rates. I'm persuaded that the valves themselves can take such a licking, but I wonder if - at very high pulse rates - the blood will be beaten around by the metal blades or if the turbulance will trigger damage or thrombosis or some such thing. All of the literature that I've found seem to emphasize endurance sports - running a marathon or swimming a mile, for example, which require that the heart rate stay in an aerobic zone for a longer period - that is, sports that require a lower rate than you'd see in a swimming sprint or middle-distance race - and I'm worried about what happens to the blood when the pulse goes over 175 ... Meanwhile, I appreciate Duffy's comment that it'll take longer than I hope to get back in the water ...

 

[epstns]

I can't comment on the capabilities of the mech valve, as I have a tissue valve. But I will echo Duffy's sentiments about taking it slowly as your sternum heals. I was a 5 days a week gym rat almost right up until my valve replacement at age 63. At that time my morning routine often included up to 150 or more push-ups. I'm now almost 2 years post op and have just gotten back to being able to comfortably do 50 push-ups. Maybe I could have pushed myself harder and gotten there sooner, or could have gone farther, but it just hasn't felt right yet. Still working on it. Just give it time. We all heal at different rates, but with any luck, we all do heal.

 

[Duffey]

Jim, I have a bovine valve so I have never researched the specific mechanical valve questions you ask about. However it does make me wonder why, if you're over the age of 60, you would chose a mechanical valve if you have these concerns. I understand your hope "to live a long time", but although I shared the same desire to live a long time it did not dissuade me from choosing a bovine valve when I was 53.
You might also try the forum, cardiac athletes. Many VR members also frequent that site. It's possible that a member of their group will be able to specifically answer your questions. They are pretty equally mixed between those with mechanical valves and those with non-mechanical. http://www.cardiacathletes.com/
I look forward to hearing more about your recovery and your return to competitive swimming, so please keep us updated.
Mary:smile2:

 

[Ola Thoresen]

Re: Competitive swimming with a mechanical aortic valve ...

While I am significantly younger, only 37, I just got a mechanical valve 7 weeks ago. I have never been a competitive athlete, but used to play squash (racketball) and some semi active bicycling.
I was back on the bike after about 3-4 weeks, going a bit slow for a while, but already a week ago my endurance was better than before the operation.
Yesterday was my first squash session, and I felt in better shape than ever before, (and I was not in a particularly bad shape before) but of course I had lost quite a bit of strength in my arms and shoulders after not using them for six weeks.
During my exercise I always use a pulse belt, and my pulse is slightly lower than it used to be. I have no problem reaching the same maximum as before, it is just the average that is lower (which is probably a good thing).

I think squash is quite similar to the effect of "long-sprint". Intervals of very high activity for a few minutes, using both arms and legs with maximum effort for short bursts of time.

Now, this is less than two months after surgery, so I strongly believe I will be even better in a few more weeks. All in all I do not think you will have any problems with your mech valve.

 

[JimCA]

I agree: squash places demands on the heart that are similar to the demands of a middle-distance swimming sprint. Your experience is encouraging - and the fact that you had that experience with a young heart (which, no doubt, packs more punch than my 62-year-old heart) is even more encouraging ... Thanks, Ola

 

[Bean Counter]

I dont have an answer for you, but you may find this article of some interest. My surgeon replaced his BAV with a mechanical valve and he resumed his collegiate swimming career.

http://www.nbcnews.com/id/28494362/

http://www.youtube.com/watch?v=ULpmw6QKrC0

Good luck

 

[JimCA]

Thanks for those links about Danny Thrall …

His case is very much to the point of my question: he swims two of the events that demand the greatest explosive power and the highest heart rates: the 50-yard and 100-yard freestyle. His surgery, to repair his aorta and implant a mechanical valve, was in October 2008 – not long after he had transferred to Fordham to swim in its Division I program.

His time in the 50-yard freestyle – :22.83 in the 2009-10 season, just after his surgery – was so-so by the standards of Division I swimming, but is several body-lengths faster than I can imagine swimming at age 62.

But he improved sharply in his next season - 2010-11, his senior year – ranking in his team’s top times with a respectable 50 free of :21.59. Interestingly, he also had a pretty competitive 100-yard free, which is a race that taxes the heart an awful lot.

Here are Fordham top swimming times for the 2010-11 season, Danny’s senior year:

50-yard freestyle
Billy Colton - 20.85
Devon Morris - 20.88
Shintaro Noguchi - 21.09
Danny Thrall - 21.59
Chris Schneck - 21.71

100-yard freestyle
Billy Colton - 45.83
Devon Morris - 45.93
Shintaro Noguchi - 46.35
Nicholas Belfanti - 47.47
Danny Thrall - 47.72

From this, I’d say it’s possible to swim fast with a mechanical valve …

 

[SumoRunner]

I swim like a jellyfish, just sort of float lazily along for 1000 meters or so. But I like to run track distances of 800m & 1 mile and those can push your HR through the roof. You start sucking wind at the half way mark and then see how much pain you can tolerate for the remainder. I've done maybe 70 track races since the AVR, but don't rush back into it. My first hard race was about two years after OHS. Until then I ran easy 5/10/15ks and the like.

 

[kodi]

I pretty much agree with Duffey, why mechanical that requires coumadin or other blood thinners. I also have a Bovine and exist very happily that I don't have to do drugs. Also check out the CA site. I know there are guys there that are IRONMAN competitors with really good times.

 

[jumpy]

Sorry, but what is the CA site?

 

[Duffey]

Sorry, but what is the CA site?

http://www.cardiacathletes.com

From the cardiac athlete forum home page:

If your cardiac recovery has been so good that your cardiologist has agreed to let you return to your favourite sport "so long as you don't over do it!" then Cardiac Athletes, launched in 2001 is for you.

Who are Cardiac Athletes?

• People with heart conditions
• People who have completed
a Cardiac Rehabilitation
Programme
• Medically cleared to do sports
again
• Beginners, amateurs and elites
• Males and females of all ages
• They are 'pioneers'

 

[Ovie]

3 months after my AVR I was in the pool doing laps, I've never been a competitive swimmer, and am fairly young (25 at the time) I was pretty weak at first in the pool as I was using muscles I hadn't used in some time, however after a bit I was pushing myself to the limit with laps in the pool and my heart rate got to about 170 bpm maybe 180. I have a St Jude, however as said, people heal different then others, bring these all up to your cardiologist and Surgeon and just go with their recommendation. Hopefully they tell you you'll be fine to hit the water again and compete.

Best of luck!

 

[MarkU]

I'm 59 ands will be 60 in May. I got my St. Jude valve back in December 2000 and have been on Coumadin since then. I chose a mechanical valve on the recommendation of both my surgeon and cardiologist to reduce the probability of future surgeries. Being on Coumadin for the last 13 years has been mostly a non-issue.


Prior to my surgery I had developed some left ventricular hypertrophy and my resting HR was in the mid-70's. During my recovery my cardiologist encouraged me to do as much aerobic exercise as I could after my surgery, which led me to taking up triathlon back in early 2004, three years post-op. The cross-training aspect of triathlon also helped me to manage some other non-cardiac related muscle and joint issues.

I was a competitive age group swimmer until I gave it up at age 16 to focus on football and wrestling, and had not done any serious swim training for many years until I started doing triathlons. I mostly do sprint triathlons with open water swims ranging from 400M up to a mile.

I currently swim about 75,000 yards per year in training. Most of it is aerobic, maintaining a HR of around 130 bpm. My resting HR is about 41 bpm.

Assuming your surgery goes well, there probably isn't any reason why you couldn't return to something close to your previous level of performance. I certainly suggest that you discuss it with you cardiologist and get their input.

Best wishes.
Mark

 

[dtread]

JimCA, I got mechanical at 58 to avoid having to undergo a reoperation when I'm older. So far I'm glad I made that choice. I had a rough recovery. After the surgery I had to get an endoscopy (the anesthetic shut down my intestines), then a blood transfusion, then I had heart block and had to get a pacemaker. I was in the hospital nine days. Was back to about 70% or pre-op conditioning within 3 - 4 months, but it took a whole year to fully recover to near 100% of pre-op conditioning. I've had the heart rate up in the 170's many times for short periods when ascending hills on the bike. The valve has never faltered. Don't ever want to go under the knife again. Particularly when I'm older, as it was just too rough the first time around. The side effects with Coumadin have been minimal, and once I got a home tester it became a breeze to monitor INR.
Good luck!

 

[RunMartin]

Jim,
I swim most days in the morning and did the same for many years pre AVR. My swimming is back to pre3 AVR levels. I do competitive swimming but at much longer distance than you (3.8K open water). I do not think about my heart surgery now whilst exercising. I still run - I did a 25 mile race through the countryside yesterday and was 10 minutes quicker than last year. I am a little slower running these days but also a little older The main thing is not to expect too much early on after surgery - it takes a little time!

Martin

 

[JimCA]

I can’t find the words to say how much I appreciate all the comments, which are very reassuring.

As one comment suggested, I spoke about this issue with my cardiologist. He awkwardly tried to put a happy face on things – and, in the process, made me a lot less happy. He said I should be able to recover from the surgery and lead a normal life, doing everything “except maybe swimming a world top-ten time...” I said that it seems we had some things to talk about, because I had hoped to continue swimming fast.

He was unwilling to go out on a limb, and he conceded there is not a lot of data to predict my outcome. I’ve noticed this lack of data as I’ve read medical studies on the outcomes of surgeries with different valves. In one study, for example, only 6% of the large sample had a congenital condition like my bicuspid aortic valve and, in another study ofd about 1,000 patients, most patients went into the surgery as very sick men. Those studies suggest, unwittingly, that what I want to do – and, apparently, what some of the people who have posted in this thread already have done – is pretty unusual. We seem to be traveling through what my doctor calls a “data-less field.”

For that reason, the comments on this thread, actually, represent the most relevant and useful information I’ve been able to find.

From what I’ve learned from this thread, it seems there’s a reasonable chance that I would be able to return to competitive swimming. Mind you, my return won’t come over night – I plan to take it easy for a year, and if I compete before 18 months, I’ll be shooting for little more than a moral victory. But, after a long and hopefully active recovery, I think that – notwithstanding my doctors’ guarded outlook – I’ll be able to achieve the heart rates that I will need in order to once again swim fast.

One of the variables in all of this, of course, is the valve. So, a word on that subject.

I have now learned that my surgeon intends to implant a valve from Carbomedics – he’ll use a valve that’s built into the “sleeve” or aortic prosthetic. He said he’s been using the Carbonmedics valves for 20 years – and if he’s more comfortable with that and if it’s easier for him, then I'm hopeful this will mean less risk for me. In my research, I’ve come to agree with his opinion that competing valves have similar performance traits. Some studies show slight advantages to one or another valve - but none of the studies are based on large samples, and none of the studies have a large share of people with congenital conditions who were highly active before surgery. In other words, we're back to the data-less field.

Meanwhile, my surgeon noted that, with my enlarged aortic root, I’ll require a valve with a larger diameter. In my research, I’ve come to the view that the fluid flows are best in the larger valves – that is, the larger valves, compared with the same model in a smaller size, will have lower pressure gradients and less turbulence, which seem to be key drivers of adverse effects such as thrombosis. All of this suggests a reasonable possibility that the mechanical valve can have an acceptable outcome – and, for the record, I’m going with the mechanical valve because, though I value and appreciate the skill of my surgeon, I am terrified of this surgery and I hope to live longer than the life of a tissue valve and I hope to never, ever do this again.

 

[Julian]

This video I'm putting a link to has a lot of profanity but the man in the video has an aortic mechanical valve in his chest. I used work with people that directly knew this man so they talked about him a lot and that's how I found out about his story several years ago. After this video I'm pretty sure our modern mechanical valves are pretty amazing.

http://www.youtube.com/watch?v=x5xXsdWRaFw

 

[dtread]

More info on his heart problem would have been nice. Sounds like he had clogged arteries from bad diet along with valve problem. His diet sounded really bad. He should go for profanity reduction training. I would certainly agree that modern mechanical valves are quite amazing. The type of workout he does would certainly put any valve to the test. But it is different than a cardio workout such as running or biking where the heart rate is kept at an elevated rate for long periods. Weight lifting generally causes elevated heart rate during the lifting, then drops in between sets. One thing I definitely agree with him on is that the only way you're going to get (and maintain) any kind of physical conditioning is to put the time in exercising. There are not really any short cuts.