What are the [ sport ] limitations after having the Ascending aorta and AV replaced?

[bdryer]

What are the [ sport ] limitations after having the Ascending aorta and AV replaced?


As some here are aware, I'm having my AV replaced. Met with the surgeon last week and discovered my ascending aorta is also damaged.It is at 4.5 cm and will be replaced with a Dupont Dacron graft.

The surgeon stated that a mechanical AV is recommend. I have decided to go with a MHV. It will most likely be the St. Jude Regent. I was set on On-X but after talking with the St. Jude marketing rep and reading research papers, I am very confident with the Regent. My surgeon is experienced with the Regent. Hence I am very certain this will be the choice. I was assured I will be operated on by the end of Jan/11.

What are the [ sport ] limitations after having the Ascending aorta and AV replaced?

My sports are listed below for comments:
Scuba diving
water skiing
snow skiing
windsurfing
triathlon
weight lifting

Will the dacron ascending aorta graft cause the MHV sound to be louder?

Thanks

[Philip B]

Body acoustics vary among individuals so it's hard to predict what kind of noise your mechanical valve and aortic graft will make.

My aortic valve was replaced and an aortic graft was done in March of 2007. Noise really doesn't bother me although I can hear my valve at times.

As far as activity restrictions go, I've not encountered any. I do what I want... when I want. Again, the restriction thing tends to be individual and largely based upon advice and direction from the health care professionals that members deal with. My surgeon and cardiologist adhere to the belief that this kind of surgery is about getting a problem fixed so one can go on doing what one enjoys doing. I've never been an exercise junkie, but I'm really active.

I was fit and had none of the symptoms many people develop prior to surgery. Surgery, recovery, and rehab was pretty easy for me.

-Philip

[Philip B]

I forgot to mention that I'm am avid cyclist (road & mtn), sea kayaker, sailor, former skier (downhill & x-country), scuba diver, and hiker. I've done mountain event rides regularly since my surgery in 2007 and never missed a beat.

While it's not an activity I'd like to repeat, someone did the hit & run thing on me back in late June, 2009. I was back riding within a month and in early September rode a mountain event over three passes in Colorado with broken ribs and a traumatic brain injury. Having aortic valve replacement and an aortic graft didn't leave me fragile.

A couple of years ago, friend of mine had aortic valve replacement with a graft as well. He's an extreme sea kayaker in Northern California and continues to pursue full contact martial arts.

I've seen a number of posts here regarding heavy weight lifting restrictions post-op. I never had much interest in heavy lifting so it's never been a post-op issue for me. I've always focused on lighter weights with lots of reps.

Probably the best advice you can get should come from the health professionals you work with.

-Philip

[RobThatsMe]

Hi,

I think that prior to anyone providing you with a safe answer, you should provide more information about your condition.
Why did you have to have the aorta replaced/repaired? Do you have a dissection or aneurysm? Either of these two conditions will have a serious effect on the answers to your questions.

Also, according to your doctors, are you suspect to having further damage to your aorta? Ascending or descending?
Have you asked them these questions that you posted? If so, what was their response.

Several of us on here have had AVR, and live with aneurysms and/or dissections, and there are definitely some things that you must consider when making activity decisions.

Wishing you good health,
Rob

[bdryer]

Thx folks

I will have the surgery in later Jan. It is suspected that the AV is bicuspid. Opening reduced to .6cm. Dr thinks this caused the problem with the ascending aorta. Did not say if it was dissected or an aneurism. I'll have a CT in Jan to better show the results.

Regarding the sports I participate in, I'm thinking scuba may have to go. If guys with my similar condition can participate in full contact martial arts then the rest of the listed sports are a go.

My wt lifting is light / med, 8-20 reps with nothing to failure.

Thx

[SumoRunner]

The ticking sound eventually goes away. I'm almost 20 years out now and it's been a long time since I could hear it. Others often say they can hear it tick but the sound is so much a part of me I cannot hear it even if I try.

[Country]

if you have an anyerism like that then you shouldnt lift a darn thing...... i had the same deal going on.

my valve is pretty loud and i am perfectly ok with it. others around me are amazed that they can hear it.... like i said i am comfortable with the ticking!

when docs say that recreational activities are dangerous they mean it. my docs told me that everything that i have done in the past, for the most part, would be ok.

they are most worried about trauma and bleeding while on coumadin. they told me that snowboarding and back country snow mobiling are out..... but i might just take it easy with the snowboarding.

make sure you browse thru the coumidin threads in the anticouagulation section

[Philip B]

In the few responses to your original post you have examples of the different perspectives from health care professionals. My doctors said to do anything I want to. Another member reports that his doctors recommended giving up weight lifting, snowboarding and back country snowmobiling. My doctor had no problem with me continuing to back country tele-ski.

Why give up scuba diving unless you really want to? I asked my cardiologist about scuba diving and he looked at me with a puzzled look and responded that there was nothing about scuba diving that would present a risk.

I guess the best advice is to simply recommend that you have a very candid conversation with a cardiologist whom you trust and follow the advice given.

As far as risks associated with coumadin and activities, I play hard and crash fairly often. So far, I've never found myself bleeding-out. The only injury situation where I've gone to the emergency room to get checked out was the hit & run accident in which I was an unwilling participant in June 2009.

Part of this of course, is comfort factor. You'll undoubtedly feel comfortable doing some activities and uncomfortable doing others.

-Philip

[AgilityDog]

Well, I can't scuba dive anymore, but that's because my defibrillator isn't depth rated. Other than that, I'd be just fine.

[Dan]

Philip, I assume that you are on some kind of a blood thinner. I am on Coumadin and I was once an avid mountain biker. I have been recently looking to get back into the sport. I have been told mixed opinions about activities like this while being on Coumadin with a mechanical valve. I am happy to see people are out there with in the same situation as me living life to the fullest.

[dick0236]

I am happy to see people are out there with in the same situation as me living life to the fullest.

Welcome Dan. The only precaution that those of us in our "situation" need to follow is to use common sense. I can't recall a doctor ever telling me what I could not do.......maybe that's because I never asked:biggrin2:. I've never gone in for "xtreme sports", but I have done my share of waterskiing, hiking, rafting, climbing around construction(new and remodeling) and have fallen a number of times (sober and drunk). Usually, I have been smart enough to "not run with scissors". After a very normal:wink2: life, I have never experinced ANY life threatening injury or bleed. Now that I'm old, I don't do the things I used to do:angel:....but that is due to age...not my "blood thinner".

[bdryer]

Great replies folks.

Lets see, you guys have been particpating in water skiing and scuba after installation of a mechanical AV, those two sports were of the greatist concern to me. Obviously the AV replacement alone is no biggie, but I question if an ascending dacron aorta graft will pose a limitaion?

[normofthenorth]

I was supposed to get the Dacron replacement to my Aortic root, but in the end I didn't. Nobody ever told me that it would need any special care or restrictions. Some time for the stitches to finish healing and smoothing over, I'm sure.

Another thing: I went with a tissue valve, maybe mostly to avoid the Coumadin, but I'm on it now for 3 months because of the "Simplici-T" Dacron ring they put around my MV. Now that we seem to have balanced out the dose (and my wife's broccoli), it seems easy and invisible. I'm supposed to stay in the 2.5-3.0 range, and I think I've finally nailed it at 4 mg/d -- from 1.4 to 2.1(?) to 3.1 to 2.8, with tweaks to the dosage along the way. They're still taking readings 2x/week (Mon & Thurs) just to make sure, though I expect it to stay fairly settled now.

Meanwhile, I've been known to have the odd nose-bleed during this dry, cold, heating season, and the occasional touch of blood from gums or elsewhere. I've noticed nothing out of the ordinary, which is a pleasant surprise.

I am still peppered with bruises, but they're all left over from the surgery 2 weeks ago, not from later bruises while I was on Coumadin. 5 pre-op tries at an "art" line in both forearms, for example -- Yee-Yikes!! And a bright black-and-blue just above the waist-line on my right side -- I have NO idea what that's from!

[Philip B]

No, I'm not on blood thinner drugs... the coumadin I take simply causes my blood not to clot as quickly as folks who don't take the drug. My INR is maintained between 2.5 and 3.5. Yes, I bleed a little more when I crash and my bruises tend to be a little bigger and darker. I have a hard time staying upright on my mtn bike due to the technical trails I tend to ride on. Coumadin doesn't slow broken bones from healing either.

BTW, my dacron ascending aorta works just fine with the activities I do. Mine came as a factory installed conduit on my St. Jude Valve. They told me my dacron plumbing is tougher than my original equipment. My installation involved replacing most of the aortic arch.

For what it's worth, I believe there are misconceptions out there about AVR surgery and continuing an active lifestyle post-op. Others may have had experienced limitations, but I've encountered none.

The friend in Northern California, whom I mentioned in a previous post, has a dacron aorta as well. His original equipment disected and he almost died. He's very active with an extreme sea kayaking group and does full contact martial arts.

-Philip

[tommy]

Risk of bruising in any contact sport (and injury from falls) if on Coumadin. Suba and weight lifting may be restricted. Check with your doctor. There are a lot of very active and performance driven folks at www.cardiacathletes.org

[MarkU]

Prior to my surgery I was an avid weighlifter/bodybuilder. I didn't have any aorta issues, but after my surgery my cardiologist asked me cut back on the weightlifting do more aerobic exercise (which eventually led me to getting into triathlons).

Now ten years later, my cardiologist has somewhat reversed course and urged me to start doing more weightlifting in order to offset muscle loss as I get older (I'm 57).

I've never limited my activities because of the Coumadin. I wear a helmet all the time on my bike, but would do so whether or not I was on Coumadin. I've crashed at over 20 mph and hit my head hard enough to flat-spot my helmet but survived ok. Like everyone else I've heard all the horror stories about brain bleeds, but my maybe somewhat naive opinion is that if you hit your head hard enough to do that you're pretty much screwed anyway. Whatever incremental risk the Coumadin poses is something that I'm willing to accept.
I work with a guy who swears that being on Coumadin can cause spontaneous bleeds and that people drop dead all the time from it. I've given up even trying to talk to him about it.
Mark

[scott.eitman]

I beleive you have most of the answers that you need. I found it helpfull to get more and more to help confirm my decision, so here goes.

My surgery was pretty recent. I have an On-X AV and a dacron aorta and am of course on Warfarin. As my body allows, I am pretty active. I do spin classes about 3 times a week, but am not yet at 100%. I easiy take my HR to the 150 and 160s however I do get worn out too easily. When the weather is good, I will be in my bicycle outside. Active lifestyles are what the individual wants to make of it. As with any lifestyle, there are certain risk rewards. As a person who loves decending a moutain on my bike fast, I have always accepted that the risk is high. You and only you have to make this decision.

In terms of sport limitations, the question is how much risk do you want to accept with Coumadin? I say accept some risk. I can not imagine living without bicycling. Others will say WTF are thinking.

I have a buddy on coumdin for blood clots. He is a carpenter and fell off a roof recently. He told everyone around him that he was fine, but they life-flighted him to a trauma unit just to find out that he was right.

Scott

[normofthenorth]

A buddy of mine from University got the Benthall (AVR + Dacron Aortic Root) ~18 months ago, when I seemed to be headed for exactly the same. He said the best thing about the Dacron AR -- unlike the tissue valve -- was that it was "guaranteed for life, plus or minus a few minutes". Cute or what?

[bdryer]

Brothers and sisters

Holy Crap! I feel like I've died and gone to heaven! Hey surgery is later Jan, that could happen. LOL.

Other then being a lab rat to balance my INR, I will really have no huge life style changes. I will pose the question of scuba to the Doc's prior to continuing in the sport.

Wow St. Jude comes with a factory installed ascending aorta conduit? Cool! One less stitched joint to worry about. I've gotta check this baby out!

Thx

[RunMartin]

My cardiologist, when asked recently, said I could do whatever I wanted - running swimming and cycling. The limiting factor was what I could actually do! I am not quite as quick as I used to be (at the moment) but I have changed my training recently and have started to see small improvements. Warfarin, as has already been said is no big deal. I think I am a little more careful now but that could be age as well!

[bdryer]

Sheeet RunMartin

We all slow down as we age, who else is going to "stop and smell the roses" mid run or on a quad busting road bike climb. It won't be the young guy's with drool on their chins. It is us who will give credit to the statement. We have a responsible job to do bring realism to the statement.

I read on a scuba forum about a guy with a mechanical valve who deliberately freaked out the dive masters with his ticking mechanical AV.
When the dive group stopped to smell the reef, he would sneak up and go neutrally buoyant next to him. The dive master would hear his ticking MHV but could not isolate the location. I would have loved to have have been their, hey wait that's going to be me next year! I can hardly wait to pull this stunt off. I can read the dive masters thoughts ----"OMG I have a terrorist sporting an under garment slim jim car bomb in my dive group"! Head lines read-----airport scanners installed at dive resorts. LOL!!!

Thanks for the input

[RunMartin]

Sheeet RunMartin

We all slow down as we age, who else is going to "stop and smell the roses" mid run or on a quad busting road bike climb. It won't be the young guy's with drool on their chins. It is us who will give credit to the statement. We have a responsible job to do bring realism to the statement.

Bruce

I do not quite understand what you are saying!! All I meant to say was you can do whatever you want after surgery. Your body will tell you the limits.
I think that with having had the surgery several months ago and taking warfarin I am not as "gung ho" with some of the things I do BUT I STILL DO THEM:).

Martin

[67walkon]

Bdryer, I have a dacron ascending aorta and a bovine valve. They also did a maze procedure because of some afib issues that were very intermittent.

There are no restrictions on exercise. Less than 6 months after surgery, I did a metric century, or 65 miles, on my road bike. 11 months after surgery I did a cross state organized bicycle ride where we went an average of about 60 miles a day for 7 days. I played basketball, even though I am old enough to know better.

The only issue I have ever read about is the weight lifting issue. I have read conflicting things. You can't do any upper body weights until your sternum is fully healed, but after that, there are differing opinions. My personal conclusion was that a bicuspid valve is part of a connective tissue disorder that makes one more subject to aneurisms. Now I'm not too sure that aneurisms aren't caused by calcification of the bicuspid valve. In any event, if we are more prone to aneurisms, heavy weight lifting could cause a spike in blood pressure and pop an aneurism in your brain or somewhere. I don't know if that is really an issue, but I just don't lift heavy upper body weights. Staying away from heavy weights isn't an issue either cuz my main exercise activity is riding a bike 100 or so miles a week.

Good luck. You'll be able to do whatever you want!

[bdryer]

Hey gang

Thanks so much for the knowledge that I can pretty darn well return to being me. Some minor limitations accepted!

[Bean Counter]

Hit the 6 months post op mark today and did a stress test. The cardiologist went ahead and removed all running restrictions. My weekly running mileage the past few weeks has been about 50 miles.

[Philip B]

This kind of surgery is simply about getting something fixed so you can get on with your life.

-Philip

[SumoRunner]

That's right on track. The sky's the limit, but you still have one more hurdle to pass. You now have to start seeing yourself as an athlete again and not a cardiac patient. Put away the attitude that you may be handicapped by this and return to being you again. Beware, shedding that baggage is a tougher assignment than you might think. It took me years.

[tprice54]

Listen to my man Jack....he's been doing this a long time!

[bdryer]

Hey gang

Thanks for putting this set back in the right perspective!

I'm agreeing with others, the wait is the worst! I'm a doer, having the surgery behind me gets me doing, IE recovery, rehab, rebuilding and finally performing and enjoying my new found fitness.

Thx