Returning to exercise after valve surgery

[Chuck C]

For those of you already on the other side, how has your return to exercise gone for you?

- Are you able to exercise at the same level as before surgery? If so, how long did it take to return to pre-surgical levels?

-I am well aware that many had symptoms which impaired physical exercise just prior to surgery. If this is you, what about your level of exercise intensity prior to symptoms compared to your post surgical condition now?

- This question is not at all limited to athletes, but if you are an athlete, have you been able to return to the same level of your pre-surgical performance?

- Please let us know which procedure you had done as well. Tissue, mechanical, Ross, TAVR?

I was very physically active leading right up to my surgery. I'm 14 weeks recovered from my aortic valve replacement surgery and have a St. Jude's mechanical valve. I am back exercising somewhat vigorously. Although I have decided not to push myself 100% yet, I'm pushing pretty hard and feel great doing so. I'm doing about 60 to 75 minutes of cardio exercise per day and lifting some light weights as well. Here is what I am not sure of yet- not sure whether I will be able to return fully to my pre-surgery performance levels. When I am in the gym doing 75 minutes on the elliptical or stationary bike, I feel just as good as I did prior to surgery. But for me, the way I can really measure where I am at is timing myself hiking to the top of Mt. Monserate. From time to time I would go all out and see how quickly I can make it up, so I have some good data on where I was at pre-surgery. Although I have not gone 100% yet post surgery, I pushed myself relatively hard a couple of weeks ago and my time was significantly slower than before surgery. It may be that I need to build back up the strength and stamina ,but at the moment, the low times I was getting prior to surgery feel out of reach. I'm not discouraged and I know that it will likely take more time to get in top shape again, but the jury is still out for me as to whether I can get fully back there. If I don't it's not that important really, as I can't think of anything that this would keep me from doing.

 

[almost_hectic]

Id give it time. Prior to my mech valve I thought I was fine with no limitations. I think I was wrong and just didn't realize I wasn't all that great. After surgery returning to "normal" was slow. After say 4-5 months I thought I was back to where I was, but then surprisingly I kept improving over the next 6-9 months. Before surgery I thought I was fine but I guess my decline in strength and stamina was so slow I hadn't even realized I was in decline. I exercised and thought I was in fairly decent shape, but by no means a top athlete by far.

I also did go to cardiac rehab, but for 8 weeks instead of the usual 12 (my nasty boss insisted I return to the office which left no time) I found rehab helpful and I would recommend anyone go to cardiac rehab after your surgery. You might think you don't need it but I found it helpful to be able to feel safe exercising with rehab therapists in the room until you gain your confidence. They will push you a bit and can answer lots of questions. Plus you meet many other heart patients which was interesting. Even though you'll find most of them are all there because they either had heart attacks or bypass surgery for blocked arteries. And most are pretty old. I was a youngster at 44, but there were a couple people younger than me. One girl was 20 something.

 

[oo0My_Valve0oo]

Hey Chuck,

I know this is almost 2 months past your post but when I read your post I wanted to say that it took you 50+ years to reach the level you were used to before the surgery. You may have been at that level for decades I don't know but heart surgery is significant. You may feel great at this point (14 weeks at the time of your post) but the proof of how great things are comes with a demonstration of ability.

One of the things I have learned is how I don't have senses to accurately measure myself in terms of the heart. All the things I relied on throughout my life were only good when my heart performed at a certain level. Some of that was taken for granted while some of it was not recognized until after the heart was compromised. I can feel when there are blood flow issues, that was a revelation when I first became aware that something was wrong and ultimately saw a doctor about it. But I am oblivious to other things I do not know exist until I reach a limit and things give out. I can feel like I can do something but I reach a point then I have had to stop because I have run out of something needed to continue. It is like I have 7 sensors but you need 12 or more to detect and anticipate how you will really do at a given task. Maybe eventually I will become aware of and develop new sense-abilities.

 

[Chuck C]

You may feel great at this point (14 weeks at the time of your post) but the proof of how great things are comes with a demonstration of ability.

Hi Michael,
Thank you for your reply. I'm now 5 months out and got the green light a few weeks ago from my cardiologist to go 100% on all things cardio. Saturday was my first day back boxing and I sparred for 10 rounds without a break, other than the 45 seconds the coach gives us between rounds. I'm on anticoagulation and so I asked each of my partners to only go 20-30% power with head shots, which is really how you are supposed to train in sparring, unless you are doing "live" rounds training for a fight. I did tell them to push the cardio. I felt really good, better than I expected my first day back. I have been training carding moderately hard for a few months and hard for the past 3 weeks, but was not sure how I would hold up during sparring. Anyone who has boxed will tell you that sparring really taxes the cardio. So, I feel that my mechanical valve passed the test.

 

[oo0My_Valve0oo]

Wow that is amazing. Did your valve work take place through a sternum opening? You do not appear concerned about taking a punch to the chest.

I see a lot of inconsistency reading all over the internet and every person from the top to the bottom presented conflicting information in my healthcare system regarding this procedure. I gather there are good and bad points on either side of mechanical vs. biological valve types. Somehow I would have thought a biological would be the choice of an athlete because of the anticoagulation factor.

I chose the biological valve. I heard that they last longer than what is frequently quoted everywhere and they are on the verge of new technology so by the time mine needs replacing they will probably do it far less invasively. Even the term non-invasive means something much different depending on the person or hospital speaking of it. My procedure was described as non-invasive and also a mini-sternography but it was essentially a traditional sternography just with an incision half the size. Fortunately my surgeon employs a technique wiring the sternum in such a way that you do not have the typical restictions of arm movement. I was surprized at how the PT team knew more about it than my nurses. I would have thought they would know as much about the specific surgeon and his technique as the PT team.

 

[Chuck C]

Good questions Michael.

Did your valve work take place through a sternum opening?

I had the same procedure as you did, the mini-sternotomy.

You do not appear concerned about taking a punch to the chest.

Nope. I am more concerned about taking a punch to the head, as I am on anticoagulation. I only choose to go with training partners who have control. My incision is fully healed and the bone should also be at 100%, according to my cardiologist. Now, I am still not doing BJJ with 250 pound opponents who might put a knee on my chest and, yes, that can happen in BJJ. lol

Somehow I would have thought a biological would be the choice of an athlete because of the anticoagulation factor.

At age 53, I chose a mechanical valve, as I did not want repeat surgeries. I was leaning towards biological, due to my combat sports, but after a good deal of research and after learning from other members on this board that I can still have an active life on anticoagulation, I decided to go with mechanical.

Although there is hope that the new tissue valves will last longer, there is not yet any evidence that this is true as they have only 5 years of published data for the Resilia Inspiris, the valve that they hope will last longer. At my age of 53 at the time of surgery, a biological valve would have been expected to last about 10 years, with the caveat that "we hope this new one will last longer, but we can't say for certain." So, I went with mechanical, as the valve I went with is expected to last the rest of my life and I felt that if I went with the data that I would probably face reoperation at 63 and then again perhaps in my early to mid 70s. TAVR is a great option for some patients, but the longevity is not certain and what a lot of folks don't realize is that not everyone will be eligible for TAVR. They have to evaluate many factors, including the distribution of the calcification of your valve, before they can determine if one is a candidate.

Also, virtually every medical guideline recommends a mechanical valve if one is under age 60, which would be expected to last a person to the end of their life without the need for reoperation. Still, I do understand when people choose to go tissue valve when they are my age. If the new tissue valves end up lasting 15-20 years for a 50 year old and then they are lucky and they qualify for TAVR and then get another 15-20 years out of the TAVR and then are lucky again and qualify for another TAVR, this time a TAVR in TAVR that takes them to the end, then I would imagine that the person would be glad with their choice to go that direction. A lot of people these days in my age group are making that choice with that hope and I do understand this. But, the data is just not there yet to say that this is realistic. Although I tend to be an optimistic person, I did not feel comfortable leaving so much to chance.

 

[Brinntache]

I am one month behind you.
51, mechanical AVR 29mm April 22 2021 + ascending aorta replaced. Recovery delayed with a pericardial effusion dropping event. woo hoo.
Chose mechanical over bio or Ross for the same reasons: one and done.
I am way ahead of where I was before surgery, or even summer 2020. Trying to get back to where I was in 2019. My measuring stick is cycling. Would love to get back to where I was in 2015.
Still feeling soreness in my chest, can't do a push-up, don't enjoy coughs. Can't sleep on my side. Got a pile of muscles that are out of wack compensating for others. The pec muscles aren't back doing their job, so a lot of their work is being done by the shoulder muscles and weird muscles in the armpit I didn't know I had. (just like all those inside the rib cage.)
Cardiac rehab programs still haven't reopened since covid hit, so it is hard to get guidance on how hard to push or what steps to get there.
No punches to the chest. Chuck, like really? Of all the things to get back to...lol never stop being you.

 

[BillDaThrill]

Chuck C - great to hear about the boxing clearance and initial success and continued excellent recovery. "Float like a butterfly..."
Am now 10 weeks out post-op and played beach volleyball for the first time since surgery. Was a little sore afterwards but it sure feels great resuming what I did prior. Am running on a treadmill in cardio rehab and looking forward to being allowed to mtn bike (they are a bit freaked out by the rocky trails here). Am loving recovery, had no idea that it would be 'fun'. Keep kicking tail!

 

[Michael O]

Well done. Congratulations.

"250 pound opponents newly minted blue belts who might will put a knee on my chest and [because they just learned it], yes, that can happen in BJJ. lol" FIFY

 

[oo0My_Valve0oo]

I am amazed at what you all have been doing. I am only finishing my 9th week and I am concerned about my ability to step back into my work. I need to return as soon as possible. I could not do it until at least the 8th week when you can drive and lift more than 10lbs. Part of my job involves driving and carrying three and more times that.

I have experienced respiratory problems, an impractical limit on stamina and it seems as though I am unable to produce the blood flow to walk several blocks as my legs feel heavy. I was stronger in every way earlier in my recovery but I have had these setbacks present for weeks. I have been hoping they would have improved by now.

Things can improve significantly overnight and some other things have. The most I have done since the 8th week easing of some limitations is jog across the parking lot then continue to scramble through the large hospital to get to an appointment (ironically a stress test). Earlier I would have worried about potentially overdoing things. Now I feel like I have permission to push. But compared to what I have read in this thread I am lagging behind, even though I know it is different for every person.

 

[Chuck C]

I am amazed at what you all have been doing. I am only finishing my 9th week and I am concerned about my ability to step back into my work. I need to return as soon as possible. I could not do it until at least the 8th week when you can drive and lift more than 10lbs. Part of my job involves driving and carrying three and more times that.

I have experienced respiratory problems, an impractical limit on stamina and it seems as though I am unable to produce the blood flow to walk several blocks as my legs feel heavy. I was stronger in every way earlier in my recovery but I have had these setbacks present for weeks. I have been hoping they would have improved by now.

Things can improve significantly overnight and some other things have. The most I have done since the 8th week easing of some limitations is jog across the parking lot then continue to scramble through the large hospital to get to an appointment (ironically a stress test). Earlier I would have worried about potentially overdoing things. Now I feel like I have permission to push. But compared to what I have read in this thread I am lagging behind, even though I know it is different for every person.

Hang in there Michael. 9 weeks out from surgery is still very early. At that point I was probably not doing much more than brisk walking. If I recall, that was probably about the time that I started returning to hiking up the mountain, but I did it very slowly and with a heart rate monitor on. I think that the limit that I put on myself was to not let my HR get over 120 at first.

Take all the time you need to get back on track and don't rush things. You have all the time in the world to get your stamina back and it will come with time. I would say just keep trying to walk, per the guidelines that you were given, and go as slow as you need to feel comfortable doing so. I'd have to check my notes, but I'm pretty sure that I did not do much more than walking for the first 10 weeks.

 

[Brinntache]

Michael, 9 weeks is early, and there is a real risk of setbacks if you push too hard too early. And it is still early.
But don't ignore symptoms, tell your doctor. I ignored them and ended back in the hospital to drain my heart sac. (Pericardial effusion).
I'm at 4 months and probably 90% recovered. Like Chuck I was only walking the first 10 weeks.
Stay positive and give yourself time.

 

[almost_hectic]

I don't recall how many weeks it was after surgery but I tried to lift something in my yard and WOW! Thing isn't even heavy and it felt like my sternum was on fire

 

[Eva]

Be patient…what your heart and body went through was hard. Give them time to heal at their own pace!

 

[Michael O]

Thanks to all who commented on this thread. It's very reassuring to be reminded that recovery milestones are often measured in months, not weeks. I'm at 5 weeks and itching to get back to yardwork, heavy bag, etc, even though I know that treadmill/rowing/walking is what I should be doing now. FWIW, I was sleeping on my side within 2 weeks, but the sternum still hurts if I arch my back. Coughing is ok, sneezing really makes it sting. Candidly, the biggest source of pain is my low back/hip (from the war crime of a hospital bed) and my spine between my shoulder blades. The sternum itself isn't really a big source of discomfort.

 

[Chuck C]

Thanks to all who commented on this thread. It's very reassuring to be reminded that recovery milestones are often measured in months, not weeks. I'm at 5 weeks and itching to get back to yardwork, heavy bag, etc, even though I know that treadmill/rowing/walking is what I should be doing now. FWIW, I was sleeping on my side within 2 weeks, but the sternum still hurts if I arch my back. Coughing is ok, sneezing really makes it sting. Candidly, the biggest source of pain is my low back/hip (from the war crime of a hospital bed) and my spine between my shoulder blades. The sternum itself isn't really a big source of discomfort.

Thanks for the update Michael. I can relate to itching to get back to hard physical work. But, so critical to let our bodies heal up first during the first few months. Just give it a little time. Keep up the regular exercise and you'll be cleared for the hard stuff before you know it.

 

[carolinemc]

Be patient…what your heart and body went through was hard. Give them time to heal at their own pace!

Especially the chest muscles, the trauma from the surgery takes a year to heal, from a data entry person who worked on the computer for eight hours a day back when I was at work, before and after. I still suffer pump head moments. I had to relearn everything when I got back to work after surgery. But did better. But the hunching over the keyboard was the worst, had to slowly straighten out all the time for months.

 

[d333gs]

Good thread! I was a bit like chuck, not boxing, but pre-op ,all-out hill hiking and cross country biking. My times and performance were always getting better and I was beginning to think the Cardio was wrong. My AV size was 68 (?) up from the 30s when they first started checking. And, pre-op, besides the tiny valve, the heart and everything else was in good shape, so, after surgery, I was still more or less fit . I went to stay at a rehab place for three weeks and was hiking up hills 5k nearly every day 3 weeks post-op.
I will start week 8 Monday and I have been doing 12k cross country hard walks4 times a week since week5. Time was 1H55min two days ago, best time pre-op was 1H48min. The sternum is ok with the deep breathing, BPM tops out at 134 VS 148 pre-op.

In regards to heart behavior,I think it took a while to get used to the bigger valve. It must feel like there is no resistance to pump against.The first couple of weeks BPM would drop down to 32 at night while I was reading. Sometimes it would go up into the 90s for no particular reason. Pre op my RHR could drop to 38 but my average was in the upper 40s. Now my average is 64 , according to my Apple Watch.

I have been very careful with upper bodywork, no lifting . Although about two weeks ago I spontaneously 'stretched' in bed one morning when I was still half asleep ..........what a great feeling that was. April I will start seeing what I can do upper body-wise.

One freaky thing that did happen to me the second week was a memory loss: I was looking at Instagram posts when I suddenly realized that I did not know where I was or why I was in this particular room. It took a good hour for it all to come back , very spooky experience.


Update ; I just got back from my 12k and the time was1H 48min...........not bad

 

[Chuck C]

In regards to heart behavior,I think it took a while to get used to the bigger valve. It must feel like there is no resistance to pump against.

I really do believe this makes sense and felt the same way. Our heart spent years adapting to the gradually narrowing valve, strengthening and enlarging in order to pump hard enough to get sufficient blood to our body through the little valve. Then, suddenly, huge drop in resistance. It's as if it takes awhile for the valve to adapt to the new low-pressure environment.

 

[chebag]

I had my surgery at the beginning of August. I had endocarditis, had lost all my fitness and a lot of weight (down to about 160 from 180).

I took the first ten or twelve weeks very easy, just trying to walk 10k steps a day. Now that I'm about eight months out, I'm back to playing all the pickup sports I have time for. I played basketball Friday, Saturday and Sunday, and I played Frisbee last night. Didn't get much sleep last night, either, as I was watching BODY DOUBLE (which is hilarious and maybe even good?) until midnight. Figured I'd wake up feeling sore and idiotic, but I'm astonished that my legs aren't even sore. I said this in another thread but what an incredible difference!

Pickup basketball is something I have to be a little careful about -- don't want to get bonked on the head too hard, so I try not to crash the boards too much or jump over anyone's back (I can't do that anyway!). If I feel like I really got hit on the head hard, I'd probably head straight to the ER to make sure I didn't have a hematoma or anything. But I've been bonked a few times in the last week and am no worse for the wear.