Weightlifting w/Bentnall procedure

[Aqua_Grim7]

Hi everyone!

First time poster here, male, 27 years old. I’ve just passed the one year mark since I had my aortic valve and ascending aorta replaced via a Bentnall procedure.

My valve was severely regurgitating, and my ascending aorta was dilated the point where surgery was essentially a necessity so as to avoid the risk of a dissection in the future.

I’ve also just passed my first yearly checkup since my operation; all’s well, feedback I’ve had from my cardiologist is that my operation went perfectly and I can expect my replacement (bovine) valve to last at least 15 years until it needs replacing again.

During my checkup I quizzed my cardiologist about what kind of fitness/excercise is safe for me to do. I’ve recently started a new job where I get free gym membership and want to make the most of it!

Seems like all forms of cardio are safe, which is great as I love running and was an avid runner pre-surgery.

I’d like to incorporate weightlifting into my regime too. My cardiologist said he’s happy for me to go ahead with lifting weights, provided that I don’t go ‘too heavy.’

With this being a somewhat broad term, I pressed him further and he said that as long as I do higher reps with lighter weights, then it’s safe for me to do.

I take it that I can still do progressive overload to build my muscles back up after surgery using lighter weights, so would like to know if anyone else on here has had similar advice?

What kind of exercises would be best? What kind of rep ranges should I be looking at?

I’m assuming at least 15-20, but was wondering if there was anybody else on here who lifts weights and in particular may have had a similar procedure to me so I can be sure I’m not going too heavy on the weightlifting side!

 

[pellicle]

Hi Aqua and welcome aboard

I've been pondering this post for a while and just didn't now where to start. So lets start with me pasting things from my bio here (*I see you filled out yours a little too)

early diagnosis of Aortic bicuspid at 5 YO. Surgical career: valvotomy at 11 or so, homograph replacment at 29, mechanical bileaflet at 47.​

before my surgery at 29 I had been keen on sports (squash and aikido), bushwallking, cycling and motorcycling.

So aside from the one done earlier than you (at 11 or so) we're on a similar trajectory and have similar issues: namely bicuspid aortic valve and an aneurysm.

The primary reason for my surgery at 47 was for the aneurysm but my homograft was also giving out.

I’ve also just passed my first yearly checkup since my operation; all’s well, feedback I’ve had from my cardiologist is that my operation went perfectly and I can expect my replacement (bovine) valve to last at least 15 years until it needs replacing again.

Now, here's where its going to be a bit uncomfortable; at your age I'm frankly stunned that any surgeon gave you a bio-prosthetic. This is a total certainty of a future operation. Worse the numbers he's given you are (nicest possible way to say this is) a highly optimistic view of the best possible case. Its entirely likey you will start to see a thing called SVD (Structural Valve Degeneration) by 2 years, and also likely you may be in stenosis again after 8. The figures the surgeon was citing are more in line with someone who is >65 years of age.

So unless you have some impressive reason to avoid being on (organ music from a black and white horror movie) blood thinners he has now set you up for multiple surgeries for the rest of your life. Now its true, once you are needing ah OHS there is a possibility you'll need more of them, but the primary driver for a reoperation on a mechanical valve is an aneurysm, which is treated by a Bentall procedure which you have now also had.

So I'm really hoping that you come back with the sound medical reasons that he chose not to do that.

That aside the training advice I would give you is what I did:

1. forget about training for muscle bulk, instead train for good endurance and strength
2. work on cardio ability and really you can target 140 ~ 155 as maximum training ranges and expect to hit 160 in time
3. do not do anything in lifting that requires a held breath and strain (NB valsalva maneuver)
4. do not engage in competitive sports. You must accept that you are not a high performing (lets face it) freak of nature (like top sportsman inevitably are)

I don't know what your base education level is, or what you knew before surgery, but ... well ... now you'll need to start learning about things because as sure as eggs you'll be up for your second and its good to start reading and start learning and by learning I mean critically thinking and proper analysis, not confirmation of whatever bias you may have.

I really am hoping there was some sound medical reason why you weren't put on a mechanical.

Best Wishes

 

[Chuck C]

Hi and welcome to the forum!

What kind of rep ranges should I be looking at?

I’m assuming at least 15-20, but was wondering if there was anybody else on here who lifts weights and in particular may have had a similar procedure to me so I can be sure I’m not going too heavy on the weightlifting side!

Your target of 15-20 reps should be just fine. To do that many reps, you should be doing a light enough load to be ok.
I recently confirmed with my cardiologist his guidance for my return to weight lifting. He said I'm fine as long as I don't overdo it. So, I target 10+ reps and go for training which increases my endurance and overall health, vs trying to bulk up.

Also, as @pellicle indicated, don't hold your breath as you lift. Breath continuously.

I can expect my replacement (bovine) valve to last at least 15 years until it needs replacing again.

I would agree with Pellicle that this is extremely optimistic. The younger a person is, the quicker they generally will go through a tissue valve. I had consultations with two of the top surgeons in the country and both told me to expect about 10 years out of a tissue valve at 53 years old. At 27, you would be expected to go through your valve even faster. Could it last longer? Sure, and we all hope that it does, but that is just the hope.

This is not to scare you, but just to encourage you to have realistic expectations. Knowing that you might go through your valve quickly it will hopefully encourage you to stay current with your follow up appointments with your cardiologist. Also, be aware that if you experience symptoms in the coming years that it could be your valve. You don't want to be that guy who ignores chest pains at the 8 year mark, believing that it can't possibly be your valve giving you problems so soon. Some young people go through valves very quickly.

 

[ValveAdmin]

Welcome, Aqua, congratulations on your first year and for passing your first yearly checkup. Have you decided on how much weight you should be lifting?

 

[Aqua_Grim7]

Thanks @pellicle @Chuck C - I should've added my cardiologist said at least 10-15 years not at least 15, please excuse the typo.

I’ve got quite a new valve implanted and also the valve I have is quite large (29mm) and according to my cardiologist larger valves tend to last longer, but rest assured I’m fully aware that it’ll need to be replaced at some point haha.

It was a personal choice to choose a bioprosthetic over a mechanical valve (I was offered the choice of both) as me and my girlfriend are going traveling next year and I didn’t want to be on blood thinners just yet and have the risk of bleeding/excessive bruising and having to monitor my INR whilst away. I was told young people often choose to have bio valves for similar sorts of reasons, and to me it felt like a fair trade for another valve replacement op and in the knowledge that the next one will be a mechanical valve

In terms of the training that sounds good, I’m aiming for a balanced regime with both weights and cardio and certainly not aiming to become a bodybuilder lol. I’ll probably stick to that 15-20 range, and as you’ve both suggested remember to breathe and NO valsalva

 

[Chuck C]

my cardiologist said at least 10-15 years not at least 15, please excuse the typo.

Thanks for clarifying. That makes a lot more sense.

to me it felt like a fair trade for another valve replacement op and in the knowledge that the next one will be a mechanical valve

That is an interesting plan. If you end up needing a new valve at age 37-45 and go mechanical it should be your last procedure. #2 will have more risk than #1, but most handle #2 fairly well and you will still be relatively young, so I would expect that you would do just fine. Also, in that you have already had a Bentall procedure, you are not likely to need another procedure for aneurysm. So, perhaps not "one and done", but you should be "two and done", which is not so bad.

Good luck with the training and please keep us posted.

 

[Aqua_Grim7]

Thanks for clarifying. That makes a lot more sense.



That is an interesting plan. If you end up needing a new valve at age 37-45 and go mechanical it should be your last procedure. #2 will have more risk than #1, but most handle #2 fairly well and you will still be relatively young, so I would expect that you would do just fine. Also, in that you have already had a Bentall procedure, you are not likely to need another procedure for aneurysm. So, perhaps not "one and done", but you should be "two and done", which is not so bad.

Good luck with the training and please keep us posted.

Yeah, that’s kinda the way I figured it. My doc has assured me that the mechanical valve can be fitted through keyhole surgery so I won’t have to go through another massive operation where my sternum is split in half again.

Definitely two and done though, I’ll be happy for the next operation to be my final one! And I will do, thanks for your reply

 

[pellicle]

Good morning Aqua

Thanks for responding.

... I should've added my cardiologist said at least 10-15 years not at least 15, please excuse the typo.

I'm glad to read that, and I want to clarify that the main reason I spoke up was I didn't want you going on thinking this (15 years and more) was the correct expectation, then going into a tail spin when you find out its less (I've personally seen much less here, anything from 2 to 8 years in younger patients)

I’ve got quite a new valve implanted and also the valve I have is quite large (29mm) and according to my cardiologist larger valves tend to last longer, but rest assured I’m fully aware that it’ll need to be replaced at some point haha.

that's about on point ... bigger is better for a number of factors.

... I didn’t want to be on blood thinners just yet and have the risk of bleeding/excessive bruising and having to monitor my INR whilst away.

well I can understand that view, back in 1992 when I was 28 and had my second OHS my surgeon mentioned the phrase "...and we don't want you on blood thinners just yet".

This turned out to have been good advice because:

1. at that time there was no portable INR monitoring kit available
2. I went on to need a 3rd surgery anyway due to an aneurysm

I don't know if he anticipated the aneurysm at that point, because I don't know if it was in 1992 yet well known that aneurysm was strongly associated with Bicuspid Aortic Valve (BAV).

Either way with my mechanical valve, a bental and home testing (as well as I also do full blown self management) everything is good

https://www.valvereplacement.org/threads/freedom-to-roam-or-unusual-inr-testing-locations.877523/
I do recognise however that at 27 there is a high probability that you are also not in the right mindset of reliable and regular functioning. I sort of was because 1) I was already accustomed to a life time of going to hospitals for checkups and 2) was in the middle of doing my second degree. This is not to be understated (being reliable and regular) because you can come to harm by failing to manage yourself (and perhaps this is also why you were guided down this path, just conjecturing).

Either way, if I'm still around when you get your mech, and if warfarin is still the drug of choice, reach out, I'll give you a hand to master it.

Best Wishes

 

[Aqua_Grim7]

Good morning Aqua

Thanks for responding.



I'm glad to read that, and I want to clarify that the main reason I spoke up was I didn't want you going on thinking this (15 years and more) was the correct expectation, then going into a tail spin when you find out its less (I've personally seen much less here, anything from 2 to 8 years in younger patients)




that's about on point ... bigger is better for a number of factors.




well I can understand that view, back in 1992 when I was 28 and had my second OHS my surgeon mentioned the phrase "...and we don't want you on blood thinners just yet".

This turned out to have been good advice because:

1. at that time there was no portable INR monitoring kit available
2. I went on to need a 3rd surgery anyway due to an aneurysm

I don't know if he anticipated the aneurysm at that point, because I don't know if it was in 1992 yet well known that aneurysm was strongly associated with Bicuspid Aortic Valve (BAV).

Either way with my mechanical valve, a bental and home testing (as well as I also do full blown self management) everything is good

https://www.valvereplacement.org/threads/freedom-to-roam-or-unusual-inr-testing-locations.877523/
I do recognise however that at 27 there is a high probability that you are also not in the right mindset of reliable and regular functioning. I sort of was because 1) I was already accustomed to a life time of going to hospitals for checkups and 2) was in the middle of doing my second degree. This is not to be understated (being reliable and regular) because you can come to harm by failing to manage yourself (and perhaps this is also why you were guided down this path, just conjecturing).

Either way, if I'm still around when you get your mech, and if warfarin is still the drug of choice, reach out, I'll give you a hand to master it.

Best Wishes

Hey man! Yeah that’s no problem, when I reread I realized that I’d done a typo, I’m hoping that I can get at least 10 years but if I get slightly less than it is what it is I guess haha.

To be honest I’m kinda hoping that by the time I need it replacing again I can get a foldax one fitted…think it’s still currently in the trial process, but we’ll see how it goes.

All the best man and thanks for the advice, appreciate it

 

[pellicle]

Hi

and thanks for your reply

I just wanted to leave a thought of reality here:

To be honest I’m kinda hoping that by the time I need it replacing again I can get a foldax one fitted…think it’s still currently in the trial process, but we’ll see how it goes.

The human trials will take 5 to 10 years to be sure that these valves are safe in humans. Then we'll need 10 more years in the field to be sure that they are as durable as bioprosthetics.
The industry is focused on its main client demographic - average age of greater than 60; so they will be focusing on (as they have continued to do in the last thirty years) the 10 year outlook for a valve. After 10 years they just don't care because its fringe.

In 10 years you'll only be 37, if you pick an experiment for your 2nd valve you'll be potentially facing your 3rd surgery at 50ish. Do not underestimate the increases of death and (more importantly) the increase in risk to having ongoing health problems that aren't death which detract from quality of life (infections, pace makers, ongoing rib and sternum complaints ... the list is quite long). These are called morbidities (rather than mortalities). Here is my small experience of a 3rd operation, as it happens I'm still on those antibiotics (last test to see if I need them was here, this test was out of pocket because its not "orthodox" and cost $700). Don't be imagining that it can't be worse than that or just as many other scenarios.

Basically what I'm saying is that this is a very complex juggling act and just because the surgeons and cardios give you the simplification doesn't mean its simple.

So you should also allocate time between now and then to start learning about the options in the future, the real ones, not the Star Ship Enterprise Med Bay ones. Here is a good starter page to use for ideas to begin your research.


Best Wishes

 

[Aqua_Grim7]

Hi

and thanks for your reply

I just wanted to leave a thought of reality here:



The human trials will take 5 to 10 years to be sure that these valves are safe in humans. Then we'll need 10 more years in the field to be sure that they are as durable as bioprosthetics.
The industry is focused on its main client demographic - average age of greater than 60; so they will be focusing on (as they have continued to do in the last thirty years) the 10 year outlook for a valve. After 10 years they just don't care because its fringe.

In 10 years you'll only be 37, if you pick an experiment for your 2nd valve you'll be potentially facing your 3rd surgery at 50ish. Do not underestimate the increases of death and (more importantly) the increase in risk to having ongoing health problems that aren't death which detract from quality of life (infections, pace makers, ongoing rib and sternum complaints ... the list is quite long). These are called morbidities (rather than mortalities). Here is my small experience of a 3rd operation, as it happens I'm still on those antibiotics (last test to see if I need them was here, this test was out of pocket because its not "orthodox" and cost $700). Don't be imagining that it can't be worse than that or just as many other scenarios.

Basically what I'm saying is that this is a very complex juggling act and just because the surgeons and cardios give you the simplification doesn't mean its simple.

So you should also allocate time between now and then to start learning about the options in the future, the real ones, not the Star Ship Enterprise Med Bay ones. Here is a good starter page to use for ideas to begin your research.


Best Wishes

I’ve just read through all the thread of your experience and holy f*ck mate, you’ve certainly been through the ringer. Very sobering reading all that, and made me feel very lucky that I haven’t had any trouble post-op.

I’ll definitely bear that in mind in future…trust me I don’t want to have my sternum split again, I’m hoping that I can get the replacement done via keyhole as my Dacron graft shouldn’t ever need to be replaced. I fully intend for my 2nd op to be my final one, and if that’s a mechanical/on-x valve then so be it.

Hope you continue to stay well and that you don’t encounter any further problems in the future. You’ve had some pretty awful luck but I guess at the same time it could’ve been much worse.

All the best man

 

[pellicle]

Hi

thanks for your kind words

I’ve just read through all the thread of your experience .... Very sobering reading all that, and made me feel very lucky that I haven’t had any trouble post-op.

its the sort of stuff that happens and just doesn't get reported in the journals because surgeons are only interested in "did the valve need replacing in the first year" or 30 day then 90 day death rates (and why)

people gloss over this. Mine is not even the worst case (rather mild really) that I know of.

I’m hoping that I can get the replacement done via keyhole

unlikely unless some magic occurs in medical physics and automation. The best you can hope for is a mini-sternotomy (far from keyhole) and (if you've ever worked on a car) sometimes the covers have to come off to get at something. For example to change the steering head bearing on my motorbike (a simple part) I had to do this. Took me 2 days of swearing.

so because you already have a valve (with a metal frame in it) stitched to a dacron graft its not going to be a trivial surgery.

as my Dacron graft shouldn’t ever need to be replaced. I fully intend for my 2nd op to be my final one, and if that’s a mechanical/on-x valve then so be it.

well firstly I'm not entirely sure how the procedure goes on a valve replacement with a dacron graft, I would consult with your sugeon on the specifics of that (and I do mean specific). Think like a plumber joining hoses.

Hope you continue to stay well and that you don’t encounter any further problems in the future.

thanks for that

I've always followed the Stoic line of thought and (having done a bit of psychology during my biochem degree) am quite a student of Carl Jung. Naturally this led me to Jordan Peterson (in the last 3 or so years) and I think he phrases it well with this:

If you haven't already, I suggest his book 12 rules for life.

I always keep in mind the central tenents of Stoic philosophy

and of course my good mate Epictetus:

and right now its time for some cake and a coffee

Best Wishes

 

[Brian B]

Hi, I can comment on a few things as far as the training is concerned. 15-20 reps are better for muscle building anyway. You should be chasing a pump that stimulates the muscle. Really heavy weight is never a way for muscle—strength yes. Focus on lighter weight, more reps and the mind muscle connection. That is my approach. With my hospital stay and surgery I have lost 30lbs. From 238 to almost 200 and feel much better. Now I lift for the pump and feel. I am giving my body about another month to get the range of motion back, then will really get serious since a 30lb drop is stating with a blank slate almost. Whatever you choose—good luck