Recovery of Ejection Fraction post AVR

[DJ-Rae09]

Hi All,

I've just been through AVR and into my 7th week now.

One of the reasons I needed surgery was my ejection fraction pre surgery had dropped to 50-55% (borderline normal), probably because my BAV had been leaking severely for several years. My Cardio didn't want the EF to drop any further due to heart failure concerns.

I was curious if anyone else had a low EF pre surgery and how long did it take to recover or improve post AVR surgery? I've been told by my Cardio it should take about 12 months to improve.

Cheers,
Tim.

 

[Daniel758]

Hi All,

I've just been through AVR and into my 7th week now.

One of the reasons I needed surgery was my ejection fraction pre surgery had dropped to 50-55% (borderline normal), probably because my BAV had been leaking severely for several years. My Cardio didn't want the EF to drop any further due to heart failure concerns.

I was curious if anyone else had a low EF pre surgery and how long did it take to recover or improve post AVR surgery? I've been told by my Cardio it should take about 12 months to improve.

Cheers,
Tim.

Hello DJ-Rae09,

I had a BAV with severe regurgitation where my ejection fraction dropped well below 50% which caused my left ventricle to enlarge to (I believe but would have to check to make sure) to over 6 (I believe 5.2 is the cutoff for normal) and the walls to thicken, Afib, etc..

After surgery, it took about 2 years for the heart to completely remodel to normal size and my EF to reach 65%+.

The last 2 years of echos after that have shown no changes.

In terms of how long it took to "feel normal" again... I immediately felt "better" after surgery but It took about 6 months to really feel good and maybe another couple of months until I was feeling 100% with zero restrictions, etc.

Be patient and it'll come.

Good luck to you.

 

[DJ-Rae09]

I had a BAV with severe regurgitation where my ejection fraction dropped well below 50% which caused my left ventricle to enlarge to (I believe but would have to check to make sure) to over 6 (I believe 5.2 is the cutoff for normal) and the walls to thicken, Afib, etc..

After surgery, it took about 2 years for the heart to completely remodel to normal size and my EF to reach 65%+.

The last 2 years of echos after that have shown no changes.

In terms of how long it took to "feel normal" again... I immediately felt "better" after surgery but It took about 6 months to really feel good and maybe another couple of months until I was feeling 100% with zero restrictions, etc.

Be patient and it'll come.

Hi Daniel,

Thanks for the reply and details on your situation.

My left ventricle was also enlarged at 6.6cm pre surgery. On day 7 post AVR operation I had an echo done and my left ventricle had reduced to 5.4cm, so that was quick to remodel. But my ejection fraction was still at at 50-55%. I was told by my Cardio that will take time to get better.

I'm on beta blocker which can also help with the recovery of EF. Were you on beta blocker at all?

I'm just under 2 months post op and I feel pretty much back to normal.

I was asymptomatic pre surgery so I'm yet to see if the new valve has made a difference. Obviously it's already helped my LV and it's probably having a rest now lol. And eventually my EF and cardiac output will be improved as time goes by. I'm assuming that will help when doing exercise and when the heart is underload?

Did you find once your EF improved exercise was easier/better?

Cheers,
Tim.

 

[pellicle]

sorry mate, I can't offer anything there. I tend to glaze over when such things are mentioned by cardiologists. In fact I don't recall them discussing that with me.

I just generally feel how I'm feeling and if its good then great and only concern myself with exploration if I'm not feeling better.

Myself I've somehow felt that 3 months was a good time to be evaluating (not day by day) improvement. Although I did notice weeks after my 2nd surgery I could walk up my hill much better than the week before surgery. Still felt like I'd been hit by a bus (having been hit by a car more than once on a bicycle and motorcycle and indeed in a car that metaphor has meaning to me as I know how that felt too).

 

[Lucker]

It's nice to see that heart gets smaller and EF gets larger, but I highly doubt that cells of the heart muscle that have died from overload really recover. So it's crucial to have the surgery sooner.

 

[pellicle]

Hi Lucker

So it's crucial to have the surgery sooner.

I thought that this thread may interest you, in particular starting here: post-913244

and moving down to Astro's post

It really should be a message getting out there sooner than it is ...

 

[Daniel758]

Hi Daniel,

Thanks for the reply and details on your situation.

My left ventricle was also enlarged at 6.6cm pre surgery. On day 7 post AVR operation I had an echo done and my left ventricle had reduced to 5.4cm, so that was quick to remodel. But my ejection fraction was still at at 50-55%. I was told by my Cardio that will take time to get better.

I'm on beta blocker which can also help with the recovery of EF. Were you on beta blocker at all?

I'm just under 2 months post op and I feel pretty much back to normal.

I was asymptomatic pre surgery so I'm yet to see if the new valve has made a difference. Obviously it's already helped my LV and it's probably having a rest now lol. And eventually my EF and cardiac output will be improved as time goes by. I'm assuming that will help when doing exercise and when the heart is underload?

Did you find once your EF improved exercise was easier/better?

Cheers,
Tim.

Hello DJ,

I am on 1/2 a 25 mg Atenolol beta blocker (and have been since before my surgery, higher dosage before surgery) which for me is mainly to keep Afib away. Afib was a big problem before surgery and almost zero now (skipped beat now and then) but the Atenolol is a good preventative measure to make sure it doesn't come back.

My cardiologist also says the Atenolol helps protect my heart long term by helping it work less hard so, yes, it should help when under load.

As far as EF and improved exercise, my first post surgery echo was six months after surgery and it showed 65% EF at that time. I don't know if it was that high immediately after surgery or if it took 6 months to get there but I do know that I felt an immediate improvement after surgery and my fitness steadily improved until I was feeling 100% back to normal by month 8-9.

Overall, life's been pretty good post surgery and I have no restrictions whatsoever. In fact, I just wrapped up a project on a total cabin rehab with all the work done by myself (just to see if I could still do it, haha, and with no issues other than a knock on the head and concussion that was my fault).

My cardiologist also gave me great advice during my first visit after surgery: "You've been given your second chance, now go out and life your life."

 

[DJ-Rae09]

Hi Daniel,

Thanks again for the info! Out of interest did you have a tissue or mech valve?

I am on 1/2 a 25 mg Atenolol beta blocker (and have been since before my surgery, higher dosage before surgery) which for me is mainly to keep Afib away. Afib was a big problem before surgery and almost zero now (skipped beat now and then) but the Atenolol is a good preventative measure to make sure it doesn't come back.

Ahh right, got it. I'm currently on 7.5mg of metoprolol once in the morning. My HR in the morning pre my metoprolol is around mid 70s, blood pressure is 120s/70s. Similar to you, my Cardio mentioned the beta blocker will help my heart and EF get better.

Did your Afib / skipped beats reduce post surgery?

As far as EF and improved exercise, my first post surgery echo was six months after surgery and it showed 65% EF at that time. I don't know if it was that high immediately after surgery or if it took 6 months to get there but I do know that I felt an immediate improvement after surgery and my fitness steadily improved until I was feeling 100% back to normal by month 8-9

Ahh cool. That's a good improvement of your EF post surgery at 6 months.
My next echo is in February which will be 6 months, so keen to the improvements

My cardiologist also gave me great advice during my first visit after surgery: "You've been given your second chance, now go out and life your life."

Yep, this is exactly the way to look at it I feel the same!

 

[Daniel758]

Hello DJ,

I went tissue valve and it’s been working out pretty well. No complaints here and I feel better than I have in decades.

Best thing is I can go weeks without thinking/worrying about anything heart related. Definitely a new lease on life.

As far as Afib post surgery, I had one episode about a month after surgery that lasted a couple of hours and cleared up on it’s own.
Nothing after that.

I do still get a skipped beat or two on occasion (usually triggered by heartburn) but nothing past a couple of seconds.

Before surgery I would go into Afib every time after eating anything and it would sometimes last for hours. Long strings of palpitations would come and go randomly as well. Not a good time.

Immediately after surgery, all that was thankfully gone and it’s been nice being “normal” again.

Hang in there and do your rehab. Your body will let you know how far to push it and how quickly.

And seeing how things look to be going pretty well for you already, once you get your warfarin routine down it should be sooth sailing.

Keep me posted.

 

[DJ-Rae09]

Best thing is I can go weeks without thinking/worrying about anything heart related. Definitely a new lease on life.

For sure! Same here!

Hang in there and do your rehab. Your body will let you know how far to push it and how quickly.

Yep, I've done 4 weeks of my cardiac rehab with 2 weeks to go. I've been walking every day since starting recovery at home.

And seeing how things look to be going pretty well for you already, once you get your warfarin routine down it should be sooth sailing.

Thanks!

Yeah recovery has been uneventful to date. The first 2-3 weeks I was a bit flat. By the end of week 3 into week 4, I was feeling a lot better and getting close to being back to normal. Now I'm into week 8 and feel back to normal.....I'm back at work and driving. Back to doing activities I enjoyed pre surgery now.

My Wafarin / INR has been in range for well over a month now. I self test at home which makes it easy, it takes less than 5 minutes per test. I was worried about Wafarin pre surgery, but it's no big deal

 

[SteinBizzle]

I'm roughly 15 months post-op (Onyx mech-valve and a new ascending aorta due to an aneurysm) and just had my first "post-recovery" echo. LVEF was 30% pre-op, 42% immediately post-op and 56.7% as of a week ago. I would guess my EF has increased about 1% per month post-op (starting from the immediate 42% post-op test). Overall, feeling great. I'm also medicated for EF (Entresto + Coreg) and had a defibrillator installed.

 

[DJ-Rae09]

I'm roughly 15 months post-op (Onyx mech-valve and a new ascending aorta due to an aneurysm) and just had my first "post-recovery" echo. LVEF was 30% pre-op, 42% immediately post-op and 56.7% as of a week ago. I would guess my EF has increased about 1% per month post-op (starting from the immediate 42% post-op test). Overall, feeling great. I'm also medicated for EF (Entresto + Coreg) and had a defibrillator installed.

Hi thanks for sharing your experience. I can imagine you're feeling great coming from 30% EF to now 56% (and probably increasing). What symptoms did you have pre surgery?

My first echo will be in February so looking forward to seeing the improvements

Cheers

 

[Timmay]

Hey brotha (mech valve brotha, lol),

FWIW, I didn't wait as long to get my surgery. I think my EF was 65% prior to surgery. I had an echo at 2 months after surgery and my EF was up to 75%.

I'm now at 4 months and doing cardio 3x a week. My cardio fitness is still not back to where it was prior to surgery. It is getting better as time goes on. Today I was running at 10min/mile (6.2min/km) pace at Cardio Rehab (for short 1 min intervals). Felt really good.

 

[DJ-Rae09]

@Timmay nice one mate!

 

[svAdagioME]

you said you are on metoprolol 7.5 2x/day. I am on 25mg 2x/day six days out. I am hoping they reduce it. I feel pretty good but one thing is a lot of the day I feel my heart beating very strongly and a bit fast, like 75-80 bpm. I am wondering if this is just how it is in the early days or if it is the metoprolol. I am not on amiodarone. The strong beating is not the ticking sound, I can only hear that sometimes when it is dead quiet. i asked the nurses about it and they said it was normal. perhaps my heart is just pissed off about the unexpected daylight last week.

 

[Superman]

If anything, the metoprolol is keeping it from beating even faster. I’m also on 25 mg 2x daily. Have been for 13 years now. One if the issues I read here is that people can’t push their heart rate high enough when exercising while on the drug. Thankfully I haven’t had that issue. I can run at 150bpm and bike at about 135. Resting pulse is around 57+/-. But early on during recovery my resting pulse was in the 90’s. And that was for a few weeks. 70’s - 80’s with a solid thud seems normal during some pretty intense healing.

 

[svAdagioME]

But early on during recovery my resting pulse was in the 90’s. And that was for a few weeks. 70’s - 80’s with a solid thud seems normal during some pretty intense healing.

Thank you, good to hear that

 

[Timmay]

I just want to back up what Superman already said. The metoprolol is what is keeping your heart rate low ... and offering protection for the healing process. The strong heartbeat you feel is incredibly common. It was one of the largest changes that I noticed after surgery. Now at 5 months post surgery and I don't really notice it much at all. Yes, it still beats stronger than prior to surgery. However, I just don't notice it much anymore ... either because it has diminished, or I have become accustomed to it ... or most likely both.

FWIW, the day after surgery my resting heart rate was like 30bpm higher than normal. I asked my surgeon if I should be on metoprolol and he looked at the other doctors and asked them 'why isn't he on metoprolol?'. Talk about bad doctor communication - the surgeon expected me to be on it (to protect the work he had just done) - but the attending support personnel didn't have me on it. Good thing that I asked about it. Once on metoprolol my heart rate dropped considerably. 15-20bpm. I was slowly weened off of it over the course of a month or so. You cannot stop metoprolol cold turkey. You NEED to be weened off of it. Currently my resting heart rate is about 5bpm higher than before surgery.

 

[svAdagioME]

Thanks T. That is very useful too. I have not had to be on many prescriptions previously so it is just old thinking on my part. If they want me on a dose of it long term, fine. I am learning. It is good to have online info but this is one area where it might have given me a concern about metoprolol before the surgery that I don’t need to have. I asked the attending physician about when he came in and he said it is not like old beta blockers that used to cross the blood brain barrier too easily, it is a modern drug that works and I need it.

 

[Timmay]

Thanks T. That is very useful too. I have not had to be on many prescriptions previously so it is just old thinking on my part. If they want me on a dose of it long term, fine. I am learning. It is good to have online info but this is one area where it might have given me a concern about metoprolol before the surgery that I don’t need to have. I asked the attending physician about when he came in and he said it is not like old beta blockers that used to cross the blood brain barrier too easily, it is a modern drug that works and I need it.

I doubt that metoprolol is something that you need to be on long-term unless there is a sustained medical condition that requires it. Only you and your doctors will know if that condition exists and what it is. My recommendation would be to begin discussion of weening off of metoprolol at a certain point (1 or 2 months after surgery). Just be quite upfront with your docs and ask when you can begin weening off of it. And if their response is no then ask why they believe you need to remain on it. There should be a clear clinical reason to remain on metoprolol. For some it is high blood pressure. For others it is tachycardia. For others it is something else. But you'll want to figure that out and fully understand the reason to be on it long-term. Almost all of us are on it short-term for the reasons mentioned previously.