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holypotato

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Apr 27, 2021
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I've lurked around for a while and figured I would give another anecdote for those undergoing replacements. If anyone is in the Pacific Northwest and wants to hear more because they're facing surgery in the future, feel free to message me and I'd be happy to chat.

My history...I had a Ross Procedure when I was 15, which lasted 15 years. I didn't have any monitoring done for about 10-12 years since I felt fine and was busy so didn't think anything of it. Looking back on my records, the root/STJ had already started to grow 2yrs post-op (42mm), so it's pretty clear the Ross wasn't a perfect solution. Should have gone mechanical and replaced AA to the arch instead of the Ross, but it was still preferred at this time so went w/what surgeons suggested.

In those 10-12 years, I lifted weights and ran/stationary biked 6 or 7 days a week for 6 years (540lb 3x was my PR for deadlift @165lbs, if it's any indication of the intensity level) and never had any symptoms. A few times after high-volume sessions I would *have* to call it early and lie down for 20-30 minutes...I can't say if this was heart-related or CNS overload, but I'd suspect the latter due to diet and lack of recovery time. Running I have always been sluggish/had limited endurance - maybe 30 minutes at 6.5-7mph before I would need a break.

Finally decided it was a good idea to go in and get things checked out...which I had reached 60mm+ on my root/STJ, so it was time to get cut on again. Read up on the new tech and all the studies. Valves were in okay shape, but decided to get as much replaced as I could to hopefully avoid future repairs. So now I have a dacron ascending aorta, a mechanical aortic valve and a mechanical pulmonary valve. The mech PV was a bit of an unknown, but I found a lot of case studies of positive outcomes outside the US. Both valves are On-X. There was a slight preference here for these based on my own research - I don't think the AV side matters much at all, but for the PV the turbulence and leaflet motion seemed to be positives in my mind at the time of decision, if I'm remembering correctly. There's not a lot of data on them in the PV position, so had to invent some reasoning :)

Got stuck in the hospital post-op for longer than expected due to low INR, at day 3 I was back working albeit not efficiently. Day 4 I climbed 7 or 8 flights of stairs and more than anything felt like I got ran over by a car, but wasn't fatigued or anything. Did not do cardiac PT due to COVID-19 but didn't miss out on anything besides traffic. Just walked on treadmill for 20 minutes the first week home and added an extra 90 seconds each day after. Low fever (37.8) for 3 days with chills and sweating 2-3lbs each night. Probably should have said something to CT surgery, but chose not to. Thinking this may have been coronavirus early on.

Now more than a year out and doing well. Back to usual exercise and work routine. I got some benefit in terms of cardio out of the surgery, roughly 10bpm higher until I'm at "time for a break" point when running and able to go for over an hour at 6.5mph now. I keep my INR above 3.0 at all times, usually aiming for 3.2+ and test weekly w/at home and bi-weekly lab draws. Some of the Cleveland Clinic and European studies had some data that suggested PV fared well at higher INRs in the first 3-5 years, so I'm going with that. I'm not super concerned with clotting, but rather tissue ingrowth and epithelialization. Overall hardest part of INR management is reporting to the clinic. I eat whatever I want which includes lots of greens and purple veggies. If anyone is weighing their options, I would have to say strongly reconsider a tissue valve unless you have a specific reason. The management is easy, and there's no limitations w/anticoagulants. My job is sedentary but I am out hiking, fishing, biking, climbing, or some other extreme sport for my leisure time...just watch your head.

Doubt I'll post too much in the future, but as mentioned, wanted to give the info to the community since I'm a less common case. Hope someone finds some benefit! Stay safe and healthy everyone!
 
Thanks for posting ... I'm sure that's helpful for someone (I've already got a mech aortic and a bental, so not me ;-)

on these points I can only concur

Overall hardest part of INR management is reporting to the clinic. I eat whatever I want which includes lots of greens and purple veggies. If anyone is weighing their options, I would have to say strongly reconsider a tissue valve unless you have a specific reason
Best Wishes
 

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