My experience post mechanical aortic valve replacement

[Jeff Lebowski]

I ran a 5k in under 20 minutes and had done marathons and triathlons in my teens and early twenties. I exercised 6 days a week and never noticed any symptoms.

Greetings, first of all, I am very glad that you have recovered your health. How is your sports life progressing after aortic surgery?

For 12 years before my surgery last year, I was doing marathons, ultra-marathons and long and brisk road bike rides. I was chasing degrees in my age group in marathon and ultra-marathon races. However, as you can imagine, running, especially trail conditions, are very impactful sports. In the preoperative period, I had accustomed my heart to long-distance and brisk conditions, so let me put it this way, I was finishing a marathon with a pace of 4:50 km and my average pulse rate was in the range of 135/140 bpm.
To put it bluntly, I was hesitant to go back to running after the surgery, firstly because I wanted to put too much strain on my heart, and secondly because, as you can imagine, you haven't run for a certain period of time, and your heart works at very high pulse rates and with difficulty in the training you will do until you get back to your old self. I didn't want to do that, so I only focused on road cycling and I continue my long and partially brisk road cycling rides.

 

[Jeff C]

Greetings, first of all, I am very glad that you have recovered your health. How is your sports life progressing after aortic surgery?

For 12 years before my surgery last year, I was doing marathons, ultra-marathons and long and brisk road bike rides. I was chasing degrees in my age group in marathon and ultra-marathon races. However, as you can imagine, running, especially trail conditions, are very impactful sports. In the preoperative period, I had accustomed my heart to long-distance and brisk conditions, so let me put it this way, I was finishing a marathon with a pace of 4:50 km and my average pulse rate was in the range of 135/140 bpm.
To put it bluntly, I was hesitant to go back to running after the surgery, firstly because I wanted to put too much strain on my heart, and secondly because, as you can imagine, you haven't run for a certain period of time, and your heart works at very high pulse rates and with difficulty in the training you will do until you get back to your old self. I didn't want to do that, so I only focused on road cycling and I continue my long and partially brisk road cycling rides.

Hey Jeff,

Thats a great pace for marathons! I did one marathon in my teens and finished in 4 hours so was never at the level you were.

I have started back running slowly in zone 2 only. I train with a HR belt rather than relying on the wrist sensor on my Garmin. I saw my cardiologist yesterday and he was happy with me slowly building up my running fitness. He has advised in the long term that I avoid any sports that require long periods of high intensity as there is a very small chance (he said approx 1%) that people can get an arrhythmia post op. Worth noting that even people without valve disease have a chance of arrhythmia with sustained high intensity endurance training. I found this study interesting

 

[pellicle]

I found this study interesting

indeed ... thanks for sharing that ... I found this interesting (same paragraph as your highlight):

CV benefits of vigorous aerobic ET appear to accrue in a dose-dependent fashion up to about 1 hour daily, beyond which further exertion produces diminishing returns and may even cause adverse CV effects in some individuals.​

as this fits with other things I've read (and observed) where its been reported that 45min seems to be another "sweet spot" with some even reporting that HIIT peaks after 15 min

I've been eschewing my eScooter for my bicycle more and more lately

 

[tjay]

Hey Jeff,

Thats a great pace for marathons! I did one marathon in my teens and finished in 4 hours so was never at the level you were.

I have started back running slowly in zone 2 only. I train with a HR belt rather than relying on the wrist sensor on my Garmin. I saw my cardiologist yesterday and he was happy with me slowly building up my running fitness. He has advised in the long term that I avoid any sports that require long periods of high intensity as there is a very small chance (he said approx 1%) that people can get an arrhythmia post op. Worth noting that even people without valve disease have a chance of arrhythmia with sustained high intensity endurance training. I found this study interesting

Good job with your recovery. I'm now 6 months post-op (Bentall procedure with On-X mechanical valve) and have been enjoying running. You can review my previous post at the link below. Unlike your cardiologist, my surgeon actually urged me to resume running after 5-6 weeks. Cardiologist does not put any limits on me either.
I've been running 6.5 miles in my 1-hour runs lately, but now slowly switching to weight training.

Lot of valvers here on this platform do high-intensity endurance sports, just FYI. You can search and read about their wonderful experiences too.

Keep running.

https://www.valvereplacement.org/threads/12-week-update-work-in-process.889789/

 

[Jeff C]

Good job with your recovery. I'm now 6 months post-op (Bentall procedure with On-X mechanical valve) and have been enjoying running. You can review my previous post at the link below. Unlike your cardiologist, my surgeon actually urged me to resume running after 5-6 weeks. Cardiologist does not put any limits on me either.
I've been running 6.5 miles in my 1-hour runs lately, but now slowly switching to weight training.

Lot of valvers here on this platform do high-intensity endurance sports, just FYI. You can search and read about their wonderful experiences too.

Keep running.

https://www.valvereplacement.org/threads/12-week-update-work-in-process.889789/

Hey @tjay,

Thanks for sharing your story. It’s similar to mine in lots of ways. My pre op valve was initially regurg and then added stenosis later. I also had a mechanical bentalls with ascending aorta and ended up with a pericardial effusion.

How are you finding your running? I’m 13 weeks post op and struggling to keep my HR low. For example, the week before my op I done my usual 2 laps around the park - 7.4km in 42 mins with average HR 136bpm. This morning I done the same run in 49 mins with HR average of 145 and I struggled.

My resting HR is similar to pre op at 56 and I’m off all beta blockers.

Are you finding it hard to keep your HR low when exercising?

 

[3mm]

... run in 49 mins with HR average of 145 and I struggled.

I worry that you may be in atrial fibrillation (afib). Please talk with your cardiologist!

Once I was feeling fatigued during cardiac rehab class, but not so tired that I had to stop exercising. A few minutes later a cardiac nurse asked how I felt, because my monitor showed I was in afib. They said I could keep exercising at a comfortable pace, but they also made an appointment with an electrophysiologist cardiologist.

 

[Chuck C]

Hi Jeff.

ow are you finding your running? I’m 13 weeks post op and struggling to keep my HR low. For example, the week before my op I done my usual 2 laps around the park - 7.4km in 42 mins with average HR 136bpm. This morning I done the same run in 49 mins with HR average of 145 and I struggled.

13 weeks is still early. There are published studies that indicate that following surgery the heart continues to remodel for about 3 years and possibly longer. I've always participated in endurance sports, before AVR and after. I can say that my conditioning continued to improve for probably about 3 years after my surgery, which would be consistent with the studies suggesting that our hearts continue to remodel for a long time after AVR.

Hang in there. Your athletic feedback will likely continue to improve with time.

 

[pellicle]

Hey Jeff

there's an old saying about building on solid foundations, post surgery your recovery is your foundation.

I’m 13 weeks post op and struggling to keep my HR low. For example, the week before my op I done my usual 2 laps around the park - 7.4km in 42 mins with average HR 136bpm.

to me that's too much too soon ... I'm no expert but your high BPM makes it clear to me that your body is screaming this at you and you're ignoring it.

If you crash and burn from pushing it too hard now you risk permanent damage. I can't count how many times I've advised "small steps" but you should get the picture here. Take recovery slowly and build a good foundation.

If you put weight on concrete before its set you have stuffed it. Lets just say there are things you don't want to go wrong and being dead is the easiest (for you at least).

This morning I done the same run in 49 mins with HR average of 145 and I struggled.

I'd call this "ignoring the signs" ... I'd also call this "pushing too hard too soon" but you really should so what @3mm has suggested (conslut your cardio)

My resting HR is similar to pre op at 56 and I’m off all beta blockers.

even more so in this light

Take care

 

[tjay]

Hey @tjay,

Thanks for sharing your story. It’s similar to mine in lots of ways. My pre op valve was initially regurg and then added stenosis later. I also had a mechanical bentalls with ascending aorta and ended up with a pericardial effusion.

How are you finding your running? I’m 13 weeks post op and struggling to keep my HR low. For example, the week before my op I done my usual 2 laps around the park - 7.4km in 42 mins with average HR 136bpm. This morning I done the same run in 49 mins with HR average of 145 and I struggled.

My resting HR is similar to pre op at 56 and I’m off all beta blockers.

Are you finding it hard to keep your HR low when exercising?

Jeff, I think you're getting too worried for nothing What I read is good stuff stuff in your post. For example, "ONLY 13 weeks or 3 months" and you're able to do what you were doing before surgery in terms of (longer) distance, even if at a bit slower pace. And you're not talking about walk in the park, you're "running" around the park, and not 1 or 2 miles, rather "7.4 kms or 4.62 miles".... and that too at a very respectful pace (of 10:30 min/mile compared to 9 min/mile before surgery). You are doing amazing.

Nothing comes easy at this point (3 months post-op). Of course it would be more tiring and taxing. The fact that you're trying to get back is already quite impressive. Your recovery is quite like mine. I was about 80-85% of my pre-surgery performance at 3 month mark post-op. My target was to get around 90% within 6 months which I accomplished too. You're essentially on the same trajectory. You will continue to improve every week and month, for the next few months. You will run the same distance in 42 mins with the same ease (or difficulty) again, and soon. Just keep doing what you're doing.

As far HR, mine would "dance" all over the place for the first several weeks, while running. It would all normalize. Your heart is still remodeling, and it's going to emerge better and stronger, thanks to your running shape pre-surgery, and the fact that you're challenging yourself cardiovascularly during the all-important post-op initial recovery phase. Those who (can) do what you're doing would be handsomely rewarded. You heart would emerge stronger and better than pre-surgery state. Stay on the course.

The fact that your RHR is already back to normal is a good sign. My theory is that taking your MHR higher for a sustained effort (e.g. for >20-30 mins which's only possible doing activities such as running) in the initial post-op recovery phase allows your RHR to drop to pre-surgery state too, and sooner. You're on that trajectory too.
I imagine you're using the same watch to track HR. The wrist watches (including Garmin) are not quite accurate, so you can always use the chest strap. But then again, if your HR while running is a bit elevated (and that you're more tired), remind yourself that you're only 3 month post-op, and doing what's very admirable already. Once again, mine was "dancing" while running (or may be my new Garmin watch wasn't accurate). I wish mine was stable like yours, even if it was a bit higher

I see lot of good news in your post-surgery performance and resolve, and nothing of concern ... Keep it up, and all the best.

 

[tjay]

I worry that you may be in atrial fibrillation (afib). Please talk with your cardiologist!

Once I was feeling fatigued during cardiac rehab class, but not so tired that I had to stop exercising. A few minutes later a cardiac nurse asked how I felt, because my monitor showed I was in afib. They said I could keep exercising at a comfortable pace, but they also made an appointment with an electrophysiologist cardiologist.

Cardiac rehab works around least common denominator ... Doesn't work for people like Jeff very well. I did my own rehab and glad I did. I still went to the assigned cardiac rehab because they did good stretching exercises with lighter weights. But when I would try running on treadmill there, even if at much slower pace than what I had been doing outside the rehab, they would stop me. I told them that I was already doing it outside, but they don't listen. One time they told me that I was getting too many skipped beats while I tried running (compared to when I walked), and sent a report to my cardiologist. And when I called back my cardiologist, he told me there's absolutely nothing to worry and to keep doing what I was doing (i.e. running).

Cardiac rehabs are great for those who haven't done cardiovascular activities to any serious level before. Not for trained individuals.

PS: To your point, AFib is serious stuff. And yes, IF he's getting AFib, he needs to apply changes. But what he's reporting based on amount of running he's already doing at 3 month mark is quite noteworthy. It's quite normal to feel more tired than pre-surgery state, while running for 49 minutes.

 

[tjay]

Hey Jeff

there's an old saying about building on solid foundations, post surgery your recovery is your foundation.


to me that's too much too soon ... I'm no expert but your high BPM makes it clear to me that your body is screaming this at you and you're ignoring it.

If you crash and burn from pushing it too hard now you risk permanent damage. I can't count how many times I've advised "small steps" but you should get the picture here. Take recovery slowly and build a good foundation.

If you put weight on concrete before its set you have stuffed it. Lets just say there are things you don't want to go wrong and being dead is the easiest (for you at least).



I'd call this "ignoring the signs" ... I'd also call this "pushing too hard too soon" but you really should so what @3mm has suggested (conslut your cardio)


even more so in this light

Take care

I went thru the same thing and felt the same way Jeff is reporting, and I'm so glad I did. Not only I was able to get back to my pre-surgery state within 4-6 months, even my EF went back to 60% from 35%. I'm now 6.5 months post-op, and started lifting weights 2 weeks ago. So far, so good (with both running and lifting weights).

Given Jeff's running background, doing what he's currently doing in the initial post-op recovery phase, he would be handsomely rewarded. And both my surgeon and cardiologist encouraged me to do what I did too (perhaps given my background). I passed along the same wisdom to Jeff in my response above.

 

[3mm]

Cardiac rehabs are great for those who haven't done cardiovascular activities to any serious level before. Not for trained individuals.

A good cardiac rehab program can be very useful even for a trained individual. This does depend on the quality of the cardiac rehab program, and the people who operate the program. A patient should evaluate the available cardiac rehab programs and find one that will help them. Even professional athletes benefit from coaching!

For example, the program I used (Unitypoint Cardiac Rehab, Cedar Rapids< IA, USA) put all patients on a 6 lead EKG during every exercise session, so they were gathering data that provides insight into my performance. A particular cardiac nurse who was an athlete used this information to help me understand how I could best rehab myself. I 'm a former college athlete, currently active martial artist, etc.; but I still benefit from coaching.

tjay - I apologize if this sounds like I am arguing with you; I am not. I just want to ensure people consider their options.

 

[JoeWanderer]

Very interesting discussion here. With regards to Jeff's comments, an average HR of 145 doesn't raise any eyebrows for me, as long as the cardio has given a clearance for physical activity at any heart rate. I know "healthy" people with higher heart rates for similar effort. Personally my heart rates are very low (both resting and in exercise), I always thought that it was partly a consequence of my enlarged heart due to the regurgitation, but I don't know if this has been studied in a more thorough way. For example, yesterday I've done 16 km at 4:50/km (7:47/mile) with average HR 128 bpm, max 140 bpm. I did have some water stops since it was quite hot, but still that's some 20 bpm lower, at least, than my buddies who run at around the same pace.

I must say that, as someone who hasn't gone through surgery yet (but will soon, it seems), I worry more about the whole sternum healing process. As running does have some impact, do you think taking these longish (more than 30 minutes) runs only after 3 months is safe? This will actually be wonderful news for me, but I'm just scared about any possible impacts with regards to bone/muscle/tissue healing. Also, since we're talking about physical activity, I wonder what would be the thresholds for going back after surgery for road cycling, mountain biking, swimming, weightlifting and Pilates. I'm afraid that, aside from Pilates (which is a personalized class so it can actually help healing), all the others should be started only after 6 months maybe? As for running, I wonder when I'll be able to run a half marathon again, never mind a full 42k ...

 

[dick0236]

I must say that, as someone who hasn't gone through surgery yet (but will soon, it seems), I worry more about the whole sternum healing process.

I'd make sure I got the OK from my surgeon before I began ANY strenuous exertion affecting
my chest area.

 

[Woodcutter]

I must say that, as someone who hasn't gone through surgery yet (but will soon, it seems), I worry more about the whole sternum healing process. As running does have some impact, do you think taking these longish (more than 30 minutes) runs only after 3 months is safe?

Joe: obviously we are all different but age and fitness level will almost certainly make a difference. I actually had a 10 minute conversation with my surgeon the day before my mitral replacement specifically about how the sternum was handled. Mine was wired back together and I was interested in some of the details. As a reference, I ran my first steps about 2 weeks after the surgery and did a 5km event at 8 weeks. My biggest concern was actually slipping and falling: I was running outside and it was this time of year when roads are snow and ice covered where I live. I never felt my sternum when exercising. I did unwittingly lift a heavy weight at 3 weeks (out of habbit without thinking) and I definitely should not have .... I was pretty lucky to not hurt anything. I ended up not doing cardiac rehab because when they were ready to start me, I was already training harder (distance and heart rate) than the class was going to allow. My doctors had no problem with what I was doing (with a couple of cautionary "be carefuls").

 

[tjay]

A good cardiac rehab program can be very useful even for a trained individual. This does depend on the quality of the cardiac rehab program, and the people who operate the program. A patient should evaluate the available cardiac rehab programs and find one that will help them. Even professional athletes benefit from coaching!

For example, the program I used (Unitypoint Cardiac Rehab, Cedar Rapids< IA, USA) put all patients on a 6 lead EKG during every exercise session, so they were gathering data that provides insight into my performance. A particular cardiac nurse who was an athlete used this information to help me understand how I could best rehab myself. I 'm a former college athlete, currently active martial artist, etc.; but I still benefit from coaching.

tjay - I apologize if this sounds like I am arguing with you; I am not. I just want to ensure people consider their options.

hi 3mm, we're having a cordial discussion, not arguing of course. Thanks for saying that. I apologize too if I came across as such.

For sure, everyone must pursue cardia rehab. You did, and I did too. I was just saying that trained individuals (like Jeff in this string) can (and probably often do) also use other avenues or opportunities during the rehab. Why stop at those 3 sessions/week, 45 mins/session, mostly low-key. Trained individuals can also listen to their body (as well as their surgeons and cardiologists), and train on their own too.

There's always something to get out of cardiac rehabs. For example, I enjoyed stretching and light resistance training they offered in group sessions (with dumbbells, cords etc). I used that as a precursor for the weight training that I would eventually start on my own (which I started 2 weeks ago). However, I relied on my own for cardiovascular training. They wouldn't allow trained individuals to do more (e.g. run on treadmill there). What's wrong with "personalizing" to individual needs?

By the time, they gave me first appointment (5-6 weeks post-op), I was already doing so much on my own. I showed them my garmin profile and shared that i was a trained person until days before the surgery, and since, but they were just not interested in listening to any feedback. They treated everyone the same. But that's fine. Like I said, one can do additional things on their own too, once they settle down in cardiac rehab. I still went there religiously for 3 months, but most of my recovery was on my own.

Yes, everyone must pursue cardiac rehab with professionals, I completely agree

 

[tjay]

Joe: obviously we are all different but age and fitness level will almost certainly make a difference. I actually had a 10 minute conversation with my surgeon the day before my mitral replacement specifically about how the sternum was handled. Mine was wired back together and I was interested in some of the details. As a reference, I ran my first steps about 2 weeks after the surgery and did a 5km event at 8 weeks. My biggest concern was actually slipping and falling: I was running outside and it was this time year when roads are snow and ice covered where I live. I never felt my sternum when exercising. I did unwittingly lift a heavy weight at 3 weeks (out of habbit without thinking) and I definitely should not have .... I was pretty lucky to not hurt anything. I ended up not doing cardiac rehab because when they were ready to start me, I was already training harder (distance and heart rate) than the class was going to allow. My doctors had no problem with what I was doing (with a couple of cautionary "be carefuls").

I completely agree, and had similar experience. I was doing 5k around the same time, and then ran a couple of 10k races around 4 month mark. I was doing cardiac rehab too, but as I've stated in other responses above, most of my cardiovascular training and recovery was on my own. Sternum felt a bit tender initially when I first started running (at 6 week mark), but every time it improves significantly. By 10-12 weeks, I didn't feel any issues with it.

Until 6 week mark, I was mostly brisk walking (but significant amount like 10k in 1:45:00 at 1 month mark). Also incline walking on treadmill. Then I had surgeon appointment at 6 week mark, and I was surprised when they said that I could start running. I sure took their offer and never regretted

They didn't say sprinting-type vigorous motion for arms, but then you don't need that for running longer distances. I entered my experiences in detail in the Post-Surgery forum too.

 

[3mm]

first appointment (5-6 weeks post-op)

Gosh, that is a long delay. 2 weeks after my surgery I met with the cardiac rehab team. I had a full sternotomy, mitral valve repair and installation of On-X mechanical aortic valve; from a rehab viewpoint that is as serious as it gets. My rehab team was excited to see that I quickly rebuilt my cardiovascular system. They encouraged me to push myself, but do it carefully.

 

[pellicle]

push myself, but do it carefully.

key point ... however I do wonder if qualitative language is as good; because what one person thinks is carefully think of as being too hard.

Pushing "hard" when perfectly healthy is one thing, but when in recovery (and the heart is healing and remodelling) seems unwise.