Still struggling cardio wise running, etc. 2.8 years after Aortic Valve replacement

[MidlifeCrisis]

I just turned 48 years OLD. 2 years and 8 months ago I had aortic valve replacement open heart surgery. I had my aortic valve replied with a pig tissue valve. I've never been able to get back to the level of fitness I used to be able to get to with my supposed severe aortic valve insufficiency. For instance when I'd get in real good shape and lean and mean I could run about 8 minute miles for 5 miles. Now I run like 10 min miles and as the run goes on I get slower. I start at 10 min miles maybe and toward the end it's like 11;30, etc. and I'm pretty consistent I just seem to labor the longer the continuous cardio exercise goes on. The other day I ran 4.3 miles in the 85 degree weather and when I finished after stretching my legs felt sore or crampy it was weird and I was dizzy. Some days I take off running and have to stop after a mile or less cause I'm just not feeling it. Also if I take off like a week and a half it's like starting all over again.

I also lift weights and do some HIIT training and swimming workouts. I feel it on longer swims too but in swimming I mostly do shorter sprint like HIIT workouts like I did when I was a former college swimmer. I realize I'm lucky to be alive and able to do anything active but was wondering if anyone else had experienced anything like it. My Doctor thinks I'm doing great all my tests came out great. I look in great shape but when I tell him of my running woes he's basically like well you have a smaller valve now and you're lucky, etc. I'm only seeing Doctor now once a year for annual echo.

Anyone else experienced this???

 

[Duffey]

I swam a mile and a quarter, five days a week, almost until I had replacement. I think I was able to swim because of its cooling effect on my body. Afterwards there was the restriction on being immersed in the pool for a month, six weeks, I don’t remember now. Back stroke was my specialty but it was really hard to do due to ribs and shoulder pain. Breast stroke was hard on my knees so I really didn’t get started swimming post-op for 3-4 months. Long story short, I never regained my pre-op fitness level. It bothered me for years. There’s a forum www.cardiacathletes.org that you might try posting on. Good luck and best wishes!

 

[Protimenow]

I'm wondering why, when you were 46 years old, you didn't choose a mechanical valve? Tissue valves don't last as long as mechanical valves (mechanicals can last 50 years or more - as demonstrated by Dick238(?) on this site). I won't second guess your decision, but I wouldn't be surprised if your valve will have to be replaced or repaired some time in your life.

I don't know about your reduced endurance issues. I won't guess at the reasons -- but it sounds as if your heart may not be moving as much blood, as efficiently, as it did, say, five years ago.

So - no, I haven't experience what you describe, primarily because I wasn't as active as you are - either before or after my AVR.

 

[Paleowoman]

I never got back to the level of fitness I had prior to aortic vave replacement. I was extremely fit prior to surgery, lifting heavy weights and walking several miles per day - I even did that the day before surgery no problem. My replacement valve is small and I have moderate patient prosthesis mismatch as a result which explains my being unable to get back to how fit I was.

 

[user 15848]

For me was day and night after AVR, since i got the On-X i have the energy never had when i was 22, no one knew I had a BAV, although i always told everybody there was something wrong with my heart, now i can walk , run, aerobics and swim until the joins pains come up , but, heart, still wants to keep going at it, for me now i am alive for the first time, never had so much energy

 

[btlRickas01]

I just turned 48 years OLD. 2 years and 8 months ago I had aortic valve replacement open heart surgery. I had my aortic valve replied with a pig tissue valve. I've never been able to get back to the level of fitness I used to be able to get to with my supposed severe aortic valve insufficiency. For instance when I'd get in real good shape and lean and mean I could run about 8 minute miles for 5 miles. Now I run like 10 min miles and as the run goes on I get slower. I start at 10 min miles maybe and toward the end it's like 11;30, etc. and I'm pretty consistent I just seem to labor the longer the continuous cardio exercise goes on. The other day I ran 4.3 miles in the 85 degree weather and when I finished after stretching my legs felt sore or crampy it was weird and I was dizzy. Some days I take off running and have to stop after a mile or less cause I'm just not feeling it. Also if I take off like a week and a half it's like starting all over again.

I also lift weights and do some HIIT training and swimming workouts. I feel it on longer swims too but in swimming I mostly do shorter sprint like HIIT workouts like I did when I was a former college swimmer. I realize I'm lucky to be alive and able to do anything active but was wondering if anyone else had experienced anything like it. My Doctor thinks I'm doing great all my tests came out great. I look in great shape but when I tell him of my running woes he's basically like well you have a smaller valve now and you're lucky, etc. I'm only seeing Doctor now once a year for annual echo.

Anyone else experienced this???

I started running at age 50 shortly after I found out that I needed a valve replacement. I kept track of a few months of runs prior to surgery in 2015 and I was running 4 miles at about a 9:00 and 5 miles at about 9:30, which for me was rather good. I started running again in cardio rehab at a very slow pace and it took me almost 9 months to get my mileage back up to 3 miles 3x a week. Now I'm 63 and limit my runs to indoor tracks with occasional trail runs (used to be the other way around). Since then the best I've been able to do is about a 9:30 at 3 miles, and that's maximum effort. I haven't had the urge to increase to 4 miles and don't do charity runs anymore, I run just for me. I enjoy HIIT cycle training occasionally, and a little light weight training. I'm going to chalk up the slower pace to a combination of age and reduced valve size. For me the time is a far second to maintaining a positive attitude, and running for the pure sake of running. If time is your thing, that's great but set realistic goals that can be met and improved upon. You are your best motivation.

I'm still training for my next surgery since I opted for a porcine valve, but enjoy being coag free. I hope I still have 10 yrs on my valve and hope a TAVR will be the next procedure. But planning that far ahead is just a fool's exercise anyway.

 

[MidlifeCrisis]

I'm wondering why, when you were 46 years old, you didn't choose a mechanical valve? Tissue valves don't last as long as mechanical valves (mechanicals can last 50 years or more - as demonstrated by Dick238(?) on this site). I won't second guess your decision, but I wouldn't be surprised if your valve will have to be replaced or repaired some time in your life.

I don't know about your reduced endurance issues. I won't guess at the reasons -- but it sounds as if your heart may not be moving as much blood, as efficiently, as it did, say, five years ago.

So - no, I haven't experience what you describe, primarily because I wasn't as active as you are - either before or after my AVR.

My surgeon at UCLA and Dr. both thought it better to go tissue valve based on my active lifestyle. I was really apprehensive about a mechanical valve because of the blood thinners and the "clicking noise" a good percentage of people hear wit the mechanical valve. I'm a light sleeper and will tear up a wall to find a cricket. So, I went with pig valve in hopes that I can do TAVR later when it needs replaced. That is what my Surgeon and Dr. thought would be the case once the left side of my heart got back to normal size and with future advances in technology, etc. No problems so far other than the whining about not being almost 50 and being able to run as fast as I once could up above...

 

[MidlifeCrisis]

I never got back to the level of fitness I had prior to aortic vave replacement. I was extremely fit prior to surgery, lifting heavy weights and walking several miles per day - I even did that the day before surgery no problem. My replacement valve is small and I have moderate patient prosthesis mismatch as a result which explains my being unable to get back to how fit I was.

I'm sorry and appreciate your response it's nice to know we are not alone!

 

[MidlifeCrisis]

I swam a mile and a quarter, five days a week, almost until I had replacement. I think I was able to swim because of its cooling effect on my body. Afterwards there was the restriction on being immersed in the pool for a month, six weeks, I don’t remember now. Back stroke was my specialty but it was really hard to do due to ribs and shoulder pain. Breast stroke was hard on my knees so I really didn’t get started swimming post-op for 3-4 months. Long story short, I never regained my pre-op fitness level. It bothered me for years. There’s a forum www.cardiacathletes.org that you might try posting on. Good luck and best wishes!

Thanks I really appreciate the response. I'm sorry backstroke was so difficult. I didn't attempt swimming for a long time after surgery and when I did it was like a joke at first. I can swim now but have no base/pace like I used to. I can still go fast for a short period of time but just can't hold a pace. Of course I don't go as frequently either so theres that too. Thanks for the info!

 

[MidlifeCrisis]

I started running at age 50 shortly after I found out that I needed a valve replacement. I kept track of a few months of runs prior to surgery in 2015 and I was running 4 miles at about a 9:00 and 5 miles at about 9:30, which for me was rather good. I started running again in cardio rehab at a very slow pace and it took me almost 9 months to get my mileage back up to 3 miles 3x a week. Now I'm 63 and limit my runs to indoor tracks with occasional trail runs (used to be the other way around). Since then the best I've been able to do is about a 9:30 at 3 miles, and that's maximum effort. I haven't had the urge to increase to 4 miles and don't do charity runs anymore, I run just for me. I enjoy HIIT cycle training occasionally, and a little light weight training. I'm going to chalk up the slower pace to a combination of age and reduced valve size. For me the time is a far second to maintaining a positive attitude, and running for the pure sake of running. If time is your thing, that's great but set realistic goals that can be met and improved upon. You are your best motivation.

I'm still training for my next surgery since I opted for a porcine valve, but enjoy being coag free. I hope I still have 10 yrs on my valve and hope a TAVR will be the next procedure. But planning that far ahead is just a fool's exercise anyway.

Thank you so much for the reply. It's great to know there are others out there. Maintaining the positive attitude is key. Easier said than done...

 

[Protimenow]

btlRickasi (I hope I copied this right): Being 'coag-free' is something that some people choose, when selecting between tissue and mechanical, but having to take warfarin is really no big deal. I've been taking warfarin for 28 years, some here have been taking it for more than 50. Some of the myths about it are scarier than the actual issue of taking it.

I understand the reasoning behind having a TAVI now, with the expectation that, when it starts to fail, there'll be something better, non-invasive, and permanent some time in the future. I hope that 'future' comes for those who believe this very soon...

 

[matty]

I'm 45 and 3 years out from a Bentall's procedure. By the time I took myself (after several misdiagnosis) to a get my heart checked I had severe LVH and severe regurgitation. My cardio-thoracic surgeon he thought we "caught it just in time", referring to my heart still being able to recover from the effects of overload due to the valve incompetence.
My heart returned to normal dimensions within 12 months but my EF is now at %55. I haven't properly trained since my surgery, but I don't feel the same as I did prior, but I'm not sure if it's psychological or due to my heightened awareness now of all things cardio-vascular, mixed with a bit of paranoia and ageing ?
I'm about to step up my cycling to 100 km per week (with a fancy new road bike)..... and I more than a little curious to see if my body will still respond to training with an appropriate increase in fitness.

 

[Protimenow]

An ejection fraction of 55% is pretty good. The normal ejection fraction isn't much higher. (It's not as if a 'healthy' heart has EF in the 90s - normal ejection fractions aren't a lot higher.) I wouldn't worry much about that if I were you.

 

[Brokenhip]

Similar experience. Currently 18 months post AVR (tissue) and believe my cycling is 10 to 15% off what it was prior despite significant training, 250 - 300 kms per week. Struggle when the going becomes a little tougher, head winds, hills etc. Well behind riders that I used to be able to stick with in the past. I guess becoming older also has some effect, I am nearly 68. My cardiologist suggests I just have to lower my expectations. I am also extremely thankful that I still have the opportunity to participate even at this level.

 

[user 16827]

@matty Ejection fraction is estimated, if it was measured by a 2D echo then it isn't
an exact science.

55% is considered normal

@MidlifeCrisis it seems you are not on any Beta Blocker ? that was my first thought.

I had my aortic valve replaced but have returned to a higher cardio level than before
It took a lot of hard work though, so it is possible.
I don't necessarily think it's wise to push too much ( I'm older & a little wiser )

I admit to being a chronic cardio guy but the more i learn the less i think it
is a good idea.

Reading your post about the heat, dizziness and cramping and general fatigue on longer efforts,
are you sure you have your hydration and electrolyte levels dialled in ?

6mph is an ok pace for an older guy for cardio fitness , enjoy the running and be gentle on yourself

for reference, it took me approx 12 month to return to a pre opp level of cardio power output.
At 2yr 8 month i suspect something is out, maybe something simple too.

Are you familiar with Heart rate variability monitoring ? , you may be over training ?
https://www.myithlete.com/what-is-hrv/

 

[user 16827]

Similar experience. Currently 18 months post AVR (tissue) and believe my cycling is 10 to 15% off what it was prior despite significant training, 250 - 300 kms per week. Struggle when the going becomes a little tougher, head winds, hills etc. Well behind riders that I used to be able to stick with in the past. I guess becoming older also has some effect, I am nearly 68. My cardiologist suggests I just have to lower my expectations. I am also extremely thankful that I still have the opportunity to participate even at this level.

Wheel sucking is the way forward

 

[bobr33543]

Do you know the size of the valve used in the replacement? That can make a big difference in your ability to perform physically post surgery. I had minimally invasive AVR 7.5 yrs ago but the surgery was botched (bad sutures causing perivalvular leakage). The surgery had to be repeated 4 weeks later via full sternotomy (different surgeon of course). The first surgeon used a 19mm valve, the second used a 25 mm valve. Doesn't sound like a big difference but the second valve has nearly twice the surface area for blood travel than the first (625 sq. mm vs 361 sq. mm.). Also some valve models have better hemodynamics than others.

I am also very physically active and wanted to return to my pre-surgery activities. My cardiologist told me that I would never have been able to do so with the 19mm valve. I am somewhat lucky that the first surgery was botched because I never would have known that a larger valve was the appropriate fit. Even if I knew, it would have been a very difficult decision to voluntarily have repeat surgery for that reason.

Note: During surgery a physical measurement is taken to determine the correct size valve to use in any AVR procedure. It is not an arbitrary decision on the part of the surgeon. In other words, my first surgeon not only botched the stitching but used a smaller valve than was appropriate.

 

[Protimenow]

Maybe they only had 19mm valves available -- not good for patients, but good for inventory managers.

 

[pellicle]

I just turned 48 years OLD. 2 years and 8 months ago I had aortic valve replacement open heart surgery. I had my aortic valve ...
Anyone else experienced this???

I had my (second) AVR when I was 28 ... it took a LONG hard slog to get my fitness back. Its (in my personal experience) important to just stick at it and do not over train.

When I started in earnest to recover it was nearly 2 years after my OHS (I was stuck being sedentary doing a second degree because the economic climate changed and there were no jobs in research and dev for biochemists in Australia anymore). It took a careful approach and I began with nightly cycling because unlike running I could "down gear" and lighten the workout as well as have small rests on the down hills.

Keep your HR below 150 and just use the same tracks and know your times to any particular point. These days there are tons of good fitness trackers, use one.

When I had my 3rd OHS at 48 I had some setbacks (infection and ...) but within 3 years I was out on the lake skiing in winter as well as through rough stuff.

Slow and steady wins the race.

IF you follow this and are still hitting a hard wall take that data to your cardiologist and ask why.

Best Wishes

 

[Ladybug]

For me was day and night after AVR, since i got the On-X i have the energy never had when i was 22, no one knew I had a BAV, although i always told everybody there was something wrong with my heart, now i can walk , run, aerobics and swim until the joins pains come up , but, heart, still wants to keep going at it, for me now i am alive for the first time, never had so much energy

Wow! I’m having TAVR on 9-5-19. I hope I have that outcome.