How much difference can valve type make in athletic performance?

[nate_c]

Hi, All. I've been puzzling over this question ever since my surgery. Here's the background. I've been a competitive athlete most of my life, and in recent years switched from team sports to running and cycling. Ability to perform well is very important to me.

For this reason, my surgeon (I did extensive research and his peers almost universally regarded him as one of the best in the region) decided that a stentless tissue valve would be best option for me--although he really didn't seem to think the actual tissue valve type would make a ton of difference. (Mechanical was not a good option for me for reasons I won't get into here.) Long story short, I wake up after surgery and discover that my surgeon went with a 29mm St. Jude's epic porcine STENTED valve. He explained that after opening me up, he felt that the Epic valve would fit better with my larger valve size and could potentially provide better longevity. While I remain confident in his skill as a surgeon, I've been worrying a little that his priorities in the OR may not have been the same as mine (in terms of long-term athletic performance). If my new valve is going to slow me down, so be it, but I'm hoping that's not the case. Does anyone here have any thoughts on valve types and their impact on athletic performance? (I've done my share of googling, but haven't turned up much.) Am I just worrying over a non-issue here? Thanks in advance for any input.

 

[JeffM]

Hey Nate -

Your concern was virtually the same as mine going into surgery. I had some serious conversations with my surgeon and made sure he knew that I wanted to be able to resume my road cycling at a very high intensity level. I've been involved in numerous competitive athletics all of my life and that type of lifestyle will always be a priority for me. He explained that a tissue valve would be the best performance option because of superior hemodynamics. My research had me leaning toward a stentless valve for the same reasons as you were leaning that way. Here's what he told me about stented versus stentless. In smaller sized valves, there was a difference in performance but in the larger sizes (29mm being quite large) there is virtually none. Could he have said that because he didn't want to have to deal with the added complexities of implanting a stentless valve? I suppose, but this guy is one of the top aortic specialists in the country working in a top notch cardiac facility. So I believe him. Yesterday was my 2 year valversary and I have some physical limitations to contend with, but they are orthopedic. My heart can handle a maximum load at least as well as my healthy presurgery days. You'll notice my valve size is the same as yours. I think you'll be fine my friend and I would bet that once you are recovered and able to push a little more that you'll be pleasantly surprised by your heart's ability to work for you. You're an athlete, so you know that you need to work your way back carefully and deliberately. I'm very interested in hearing about your progress. Please stay in touch!

 

[acr]

Well I have a 29mm mechanical and I can cycle as fast (faster?) as I could pre-surgery. I'm no athelete but I can fly past most folks on the bike. Gotta remember I had a big leak before surgery so that didn't help. Maybe the blood flow rate is less than a native valve, but who cares, A couple of seconds difference here or there is no big deal.

 

[ALCapshaw2]

The parameter to compare for Athletic Performance is the Pressure Gradient across the Valve.
This parameter is highly dependent on Valve (opening) Size.

Typically, Porcine Tissue Valves have lower gradients than the Bovine Pericardial Tissue Valves.
Bovine Pericardial Tissue Valves tend to last longer than Porcine Valves.
It's too early to know how this will play out for the latest tissue valves with anti-calcification treatments.

Member Dan Tread is a very enthusiastic and happy cyclist with his On-X mechanical valve.

'AL Capshaw'

 

[Duffey]

Nate,
If you haven't looked at www.cardiacathles.com or joined, you might consider it. More than a few VR members, who are also competitive athletes, are on the site and might be able to give you more definitive information.

 

[tprice54]

Nate, I second the idea of trying out cardiacathletes....come on over! I also studied this before surgery and decided, like all other valve choice issues, there is a trade off. Also, there are no real studies, just anecdotal evidence.

 

[MarkU]

It may just be me, but I think I'd rather perform at a lower level for a longer period of time as opposed to a higher level for a shorter period of time.

I've been an athlete all my life and actually started competing in triathlons three years post op at age 50. I would challenge anyone who claims that one type of valve is better than another. There are just too many variables.

I can say with confidence that my limiters are primarily related to age, physique and athletic talent, and have absolutely nothing to do with my current cardiovascular health.

Mark

 

[Mentu]

Nate, in this year since my AVR, I've thought about how to measure the outcome. My surgeon thinks my old valve was causing limitations for decades. Now I have my spiffy new valve and as of yet I am continuing to explore my limits with it. On my road bike or walking, hills do not feel as steep. My lungs have always been in good shape but now they are working with normal blood flow and I am finding that exercise goes easier than in any time I can remember. If you trusted your surgeon to act in your best interest during surgery, there is no reason to second guess him now. Just as there was no way to know which valve would be the "best choice" for you in the long run, there is no way to know today whether the valve you have is ideal. This is one of those things we only learn by living with these devices and monitoring our health as we go. You certainly have a better future today. Today you actually have a future.

Larry

 

[Philip B]

Differences?

Differences?

I really can't speak to differences as I had no symptoms associated with my bad valve before its replacement in 2007. I can tell you that my St Jude mechanical has imposed no limitations. I cycle a lot, sometimes run, and play golf regularly. Prior to moving to Arizona in June, I did lots of century ride events in the mountains of Colorado.

The one difference I noticed following heart surgery is that my swing speed with a golf club dramatically reduced. I simply couldn't swing a golf club as fast and had to switch from stiff flex club shafts to regular flex.

Hopefully, you'll get longer service life from your tissue replacement than have been reported by other members here recently.

-Philip

 

[ski girl]

Really good to read all this stuff! My crap aortic valve has slowed me down my entire life, luckily I discovered that I can paddle reasonably well without anyone thinking I'm going to keel over (not like running, yeesh). At 39 my valve is finally causing me problems and I am off to get sawed in half on 7th October.

I think, eat, train and sleep like an athlete even though my heart has prevented any brilliant performances, and I cannot wait to see what I can do when I start getting all my blood! It seems that all I read is about people who consider 'active' to mean 'I can walk a mile'. To me, active is doing a 134km whitewater paddling race and getting in the top three women (800 people do this race and I intend to get precisely that placing in August 2011).

I'm quite insistent on a tissue valve too because my training will take me places where it would be hours before I could be extracted if I got injured. Ultimately anything is going to be an improvement on the current 0.8whatevers valve opening and mean gradient of 75somethings, but it will break my heart (pun intended) if I come out of this with a bloody great scar, three months off training, and I'm no better. So THANKS for what it written here and I will check the other group mentioned as well - and if all goes well you'll see me on the TV during the 2012 Olympics, in all the sports that don't require skill.

 

[Duffey]

Really good to read all this stuff! My crap aortic valve has slowed me down my entire life, luckily I discovered that I can paddle reasonably well without anyone thinking I'm going to keel over (not like running, yeesh). At 39 my valve is finally causing me problems and I am off to get sawed in half on 7th October.

I think, eat, train and sleep like an athlete even though my heart has prevented any brilliant performances, and I cannot wait to see what I can do when I start getting all my blood! It seems that all I read is about people who consider 'active' to mean 'I can walk a mile'. To me, active is doing a 134km whitewater paddling race and getting in the top three women (800 people do this race and I intend to get precisely that placing in August 2011).

I'm quite insistent on a mechanical valve too because my training will take me places where it would be hours before I could be extracted if I got injured. Ultimately anything is going to be an improvement on the current 0.8whatevers valve opening and mean gradient of 75somethings, but it will break my heart (pun intended) if I come out of this with a bloody great scar, three months off training, and I'm no better. So THANKS for what it written here and I will check the other group mentioned as well - and if all goes well you'll see me on the TV during the 2012 Olympics, in all the sports that don't require skill.

It's great that you are ready to get replacement behind you and then turn in one brilliant performance after another!:thumbup: Great attitude!
I'm not quite sure what you meant when you wrote," . . . because my training will take me places where it would be hours before I could be extracted." I don't know whether either valve type would impact that but perhaps you've got information that I'm not aware of.
In any case, welcome to Vr and I look forward to reading further posts.:smile2:

 

[ski girl]

Hi Duffey-

OOOOPS I meant insistent on NOT having a mechanical valve!!!

I live in Perth,Western Australia and the race I'll be training for is the Avon Descent - there is a 40km section of rapids with no access roads and little phone reception and if I were to fall out of my boat during training (when there is no water safety around) and get cut or badly bruised, it would be literally hours before I could get to any medical help and I'd be worried that on warfarin I'd bleed out before I got there.

Definitely looking forward to getting this fixed and get back to training and seeing what I can do . . .

 

[ALCapshaw2]

Ski Girl -

Do you also believe that if you nick yourself shaving you would also "bleed out"?

I suspect that if you sever an artery in the boonies, the outcome won't matter much on whether you are on Coumadin or not.

Or, do you think that you will have a Stroke if you eat anything Green?

I won't waste time trying to debunk those MYTHS in your mind.

(See the "stickys" under the Anti-Coagulation Forum if you want to learn the REALITY of Living with / on anticoagulation (Coumadin / Warfarin).

How many tissue valves do you think you will need if you live beyond age 70?

At your age, from what I've read, odds on the (admittedly older) Tissue Valves needing prelacement in 10-12 years are 50-50.

 

[Lynlw]

Ski Girl -

Do you also believe that if you nick yourself shaving you would also "bleed out"?

I suspect that if you sever an artery in the boonies, the outcome won't matter much on whether you are on Coumadin or not.

Or, do you think that you will have a Stroke if you eat anything Green?

I won't waste time trying to debunk those MYTHS in your mind.

(See the "stickys" under the Anti-Coagulation Forum if you want to learn the REALITY of Living with / on anticoagulation (Coumadin / Warfarin).

How many tissue valves do you think you will need if you live beyond age 70?

At your age, from what I've read, odds on the (admittedly older) Tissue Valves needing prelacement in 10-12 years are 50-50.

I think comparing someones concerns about Coumadin, when they are competitive white water Rafter, kyak canoe ect in the middle of no where and "get cut or badly bruised", to worrying about a bleed if you cut your self shaving, isn't really that helpful.

OF course if you get an internal injury or several bad cuts and you are hours from medical help, it can make a difference if you are on Coumadin or not, saying it it wouldn't matter is not true.

I don't see how belittling someones real concerns and comparing them to cuts from shaving or having a stroke from eating anything green is helpful or supportive.

As for how many tissue valves would a 39 year old need if they live past 70, first off CCF and MANY centers give tissue valves to patients 40 and up, but even beside that, whose to say that choosing a tissue valve at 39 because it fits in their lifestyle and goals better right now, means they will choose a tissue valve whenever THIS valve needs replaced?

 

[spartangator]

Nate,
I can't comment on the initial question of how different valve types influence performance but did want to support the general theme of really being able to do whatever you want post-surgery. Yes, there are some more things to pay attention to, but all athletes really ought to watch heart rate, exertion, diet and such anyway. It's not so different, just a little more mindfulness (and gratefulness, too ) when training.

 

[nate_c]

Really good to read all this stuff! My crap aortic valve has slowed me down my entire life, luckily I discovered that I can paddle reasonably well without anyone thinking I'm going to keel over (not like running, yeesh). At 39 my valve is finally causing me problems and I am off to get sawed in half on 7th October.

I think, eat, train and sleep like an athlete even though my heart has prevented any brilliant performances, and I cannot wait to see what I can do when I start getting all my blood! It seems that all I read is about people who consider 'active' to mean 'I can walk a mile'. To me, active is doing a 134km whitewater paddling race and getting in the top three women (800 people do this race and I intend to get precisely that placing in August 2011).

I'm quite insistent on a tissue valve too because my training will take me places where it would be hours before I could be extracted if I got injured. Ultimately anything is going to be an improvement on the current 0.8whatevers valve opening and mean gradient of 75somethings, but it will break my heart (pun intended) if I come out of this with a bloody great scar, three months off training, and I'm no better. So THANKS for what it written here and I will check the other group mentioned as well - and if all goes well you'll see me on the TV during the 2012 Olympics, in all the sports that don't require skill.

Hey, ski girl. I can identify with everything you say here. I'm also a member of the cardiac athletes forum (pretty new still to all this) and have enjoyed the support and participation at that site. You ought to head over. I didn't post this question there simply because a lot of people on that site aren't "valvers." I think you'd fit right in at CA. Give it a look.

As for what you said about mech valves: I do a lot of mountain biking on alpine and desert trails and have had serious crashes 20 - 30 miles out into the wilderness. These are the risks, and we just accept them in order to do what we love, as you well know. A broken femur, for example, that far out might be disaster, regardless of what type of valve I have. However, my surgeon felt that a mechanical valve (for me personally, given my lifestyle) would add significant additional risk in future crashes (they're going to happen). Moreover, I've had some bleeding problems in the past without being on Coumadin, so he felt that I was not a good candidate for a mechanical valve. In my short time on this site, I've noticed that the mechanical vs. tissue debate can often be a sensitive issue. From my limited perspective, I don't think it's a questions with a single "correct" answer. My surgeon and I simply decided a tissue valve would be the best fit for me at this time. In 10-15 years or so (finger crossed), when the valve starts to break down, we'll take a look at the landscape and assess the new options. It may be that at the time, reduced anticoagulation will have become standard for mech valves (on-x, etc.). It's a chance I'm willing to take, and I didn't make the decision naive to the risks.

I also appreciate what you said about finally seeing what we can do with a fixed-up heart. I'm not going to be going to the olympics anytime soon , but I've always been able to compete very well in my chosen sports. However, in the back of my mind, I always felt that I was running on three cylinders and everyone else had four. Always wondered how much difference a healthy heart would have made. In any case, I'm really anxious to get through recovery and start pushing the limits again and see if I can best my personal records in everything from the 5k to the marathon in coming years. Thinking of maybe even trying my hand at some ultras. Hoping to also be able to compete better in triathlons post surgery (swimming became very difficult for me in recent years--maybe my deteriorating valve, maybe my deteriorating form--we'll see.) In any case, best of luck to you on your upcoming surgery!

Thanks to those who posted responses here. I've enjoyed reading this discussion and I think I'm ready to quit worrying about the specific valve type, move on, and just see what the new ticker can do...

 

[neil]

agree with lyn ,hope this isnt going to turn into another boring tissue v mech thread,lets move on please

 

[ALCapshaw2]

Hey, ski girl. I can identify with everything you say here. I'm also a member of the cardiac athletes forum (pretty new still to all this) and have enjoyed the support and participation at that site. You ought to head over. I didn't post this question there simply because a lot of people on that site aren't "valvers." I think you'd fit right in at CA. Give it a look.

As for what you said about mech valves: I do a lot of mountain biking on alpine and desert trails and have had serious crashes 20 - 30 miles out into the wilderness. These are the risks, and we just accept them in order to do what we love, as you well know. A broken femur, for example, that far out might be disaster, regardless of what type of valve I have. However, my surgeon felt that a mechanical valve (for me personally, given my lifestyle) would add significant additional risk in future crashes (they're going to happen). Moreover, I've had some bleeding problems in the past without being on Coumadin, so he felt that I was not a good candidate for a mechanical valve. In my short time on this site, I've noticed that the mechanical vs. tissue debate can often be a sensitive issue. From my limited perspective, I don't think it's a questions with a single "correct" answer. My surgeon and I simply decided a tissue valve would be the best fit for me at this time. In 10-15 years or so (finger crossed), when the valve starts to break down, we'll take a look at the landscape and assess the new options. It may be that at the time, reduced anticoagulation will have become standard for mech valves (on-x, etc.). It's a chance I'm willing to take, and I didn't make the decision naive to the risks.

I also appreciate what you said about finally seeing what we can do with a fixed-up heart. I'm not going to be going to the olympics anytime soon , but I've always been able to compete very well in my chosen sports. However, in the back of my mind, I always felt that I was running on three cylinders and everyone else had four. Always wondered how much difference a healthy heart would have made. In any case, I'm really anxious to get through recovery and start pushing the limits again and see if I can best my personal records in everything from the 5k to the marathon in coming years. Thinking of maybe even trying my hand at some ultras. Hoping to also be able to compete better in triathlons post surgery (swimming became very difficult for me in recent years--maybe my deteriorating valve, maybe my deteriorating form--we'll see.) In any case, best of luck to you on your upcoming surgery!

Thanks to those who posted responses here. I've enjoyed reading this discussion and I think I'm ready to quit worrying about the specific valve type, move on, and just see what the new ticker can do...

You outlined a very rational approach Nate.

Making an INFORMED Decison is what this site is all about.

I'm less concerned about valve type than making a decision based on out of date and / or just plain erroneous beliefs about living with and on anticoagulation / Coumadin / Warfarin.

Unfortunately there are a Lot of Horror Stories about Coumadin, mostly from times when testing / measuring methods were subject to a Lot of Variation and poorly understood. Most (non-contact or low-contact) Sports can be participated in while anticoagulated with proper management of INR.

'AL Capshaw'

 

[ski girl]

Dear Al:
Yes I DO believe that I'll bleed out if I nick myself shaving, and that green food will cause a stroke. I also believe the world is flat, we never landed on the moon, and that a guy on an internet forum who has never met me is better positioned to help me decide the most appropriate valve for me than my cariologist and surgeon.

Seriously mate, this forum is supposed to be about supporting each other, not for flaming someone who is new and making her first post and frankly, quite terrified about her upcoming surgery.

Thanks Lyn for the support and Nate I'll see you over on CA!!!

 

[nngbwh]

Well I have a 29mm mechanical and I can cycle as fast (faster?) as I could pre-surgery. I'm no athelete but I can fly past most folks on the bike. Gotta remember I had a big leak before surgery so that didn't help. Maybe the blood flow rate is less than a native valve, but who cares, A couple of seconds difference here or there is no big deal.

Same here. I have a mechnical valve and i can cycle fast. A couple of seconds here and there will not make a big differences unless you are racing at the tour de
france.