Oh this is fascinating. So it wouldn’t necessarily be during a workout. Because I do lift fairly intensely. Curious whether it’s just heart rate (ie is cardio going to have roughly similar impact to lifting if HR is comparable)peak heart rate and the time that its at peak.
Valves close hard and generate jets on opening and closing, from what I've read the St Jude is the best compromise in that respect, I have not sought data on the On-X.
Think of it as the fact that a native valve is very soft while the pyrolytic carbon is very had. Both close with a tight seal, one is like a slamming door (the pyro carbon). This triggers platelets and each time the platelet gets a smack on the arse on the way through the gate that provides cumulative damage. Platelets have a half life of IIRC 10 days.
I've also missed where you have spoken to aspirin (pardon me if I missed that)
*a baby aspirin a day btw, ever since the first incident
** and the d-Dimer was a few months before my second stroke (7/19), pretty far in time from the first one (5/18)