Mechanical Valve and Intense Exercise

[conk]

MS Post ride results

MS Post ride results

The Santa Barbara MS ride is done every year in October. This year the options were 12, 30, 60 or 100 miles. I chose the 30 miles, which I believe is what I rode on the first year I did the ride.

12/18/03: I just cannot express how good I felt on this ride and the fact that when I finished, I felt better than I had in any of the other years I have done the ride. Of course I took it easier this year and tried to stay within my heart rate goals, but I did not have total success there. My average HR was 141 (not too bad) with a maximum of 166 (about 16 higher than planned), which I reached on Ortega Hill. It felt good to be able to maintain over 9 mph up and over this hill.

Now I know I'll get a lot of criticism for this decision, but I ended up getting Strep Throat a few days before the ride, but decided it wasn't really going to change the course of recovery from ST, so proceeded with the ride. Probably another day or two of dealing with a flaming throat, but the feeling I had from this ride makes it more than worth it.

 

[tommy]

Martin,

Welcome to the Forum.

You will find lots of athletes in here. My inspirers are Les Barrett and Mark Wagner - marathoners. Mark just finished his second (count 'em ONE TWO) marathon last week. Check out their (and other's) stories in the "Stories" section of this site.

I suspect that you will need more than four weeks off work, but perhaps not much more with a sedentary job. Talk that over with the cardiologist and the surgeon. Can you use vacation time as well?

 

[conk]

Martin

Martin

I really think that being in good shape prior to surgery is a significant benefit toward a rapid recovery. It's probably not a 100% guarantee, but I sure think it helps.

In terms of the activities you do, running and swimming should be no problem at all, just don't rush the recovery process. You will be amazed that in a fairly short time (6 months to 1 year), you will be right in the competitive swing of things. That's not really too much to ask for a healthy heart.

I've had my mechanical for two months tomorrow and I know my condition prior to surgery definitely helped. However, I don't think I was in the shape I was prior to my first surgery in Dec 2002. While dealing with a leaking homograft valve, I could not progress with the recovery like I will now be able to do.

In terms of the coumadin...just want to make sure that you have someone who is very competent at monitoring and doesn't make big changes in dosage.

I took only 3 weeks off from work, but I think this varies widely on job, recovery etc. Just don't push it. If you feel good then go, if not take a little more time.

 

[Bob Bates]

To One and All:

I am going in for my AVR this Monday, 11/3/03. I've opted for a tissue valve, the Carpentier-Edwards Pericardial Bovine. I intyend to get back into prior active pursuits, like jogging, backpacking, and weight trainning.

I was told by my surgeon this valve would allow me to do all of the above. Does anyone have this valve (the CE bovine), or any other tissue valve that feels restricted in any way from being as active as they want to be?

Regards,

Bob

 

[Marty]

Re: Bovine Pericardial Valve

Re: Bovine Pericardial Valve

Bob, Even though I have a mechanical valve ,I now think for most people the C-E tissue valve is the way to go. I have a friend at my fitness center who has had one for seven years .Recently he was hospitalized for severe pancreatitis; he had three surgeries', was in a coma for weeks,etc. but they pulled him through and he's now 80 years old, back at the club on the treadmill every day looking great. I really wonder how he would have done with a mechanical valve on Coumadin. His C-E valve came through all this working fine. Good luck, Marty

 

[Bob Bates]

Marty;

As a physician, and a person who is on coumadin, for you to say the CE valve is the way to go is music to my ears. Thanks for being so forthright.

Regards,

Bob

 

[HFK]

Hi Bob and Marty,
As a RN this was a concern for me ,the effects of coumadin and surgery,in the ICU I saw secondary effects of coumadin. So opted for homograft valve 3 years ago ,had good surgeon but he got a bit aggressive my aortic valve he replaced perfectly,but than decided to take calcium off my perfectly functioning mitral valve and tore a leaflet and came out of surgery with pacemaker and 2+ regurg. I now need mitral valve replacement soon as it has progressed to mod-severe regurg. But last year I had to have my R ovary removed suppose to be 1 day surgery,the surgeon nicked something and I bleed,he let me sit there for 5 days thinking it would absorb itself,I was taken back to surgery ,not by him and they removed 1245cc ( over 1 liter)of blood and fliud needless to say and very long story I was in the hospital for 30 days. The reason I am bringing this up was my cardiologist said if you were on coumadin the situation would of been MUCH worse.Every person is so unique in their personalities and medical histories,and these also play a factor in which valve can and may be used.Don't get me wrong people on coumadin have surgery and procedures done all the time a things go ok. One never knows what can come next, I certainly never thought I would have to deal with this OTHER valve situation.I am glad I found this sight,everyone has different opinions but we all have the same common denominator. HFK

 

[mike anthony]

Bob, I have posted on other post and has you know I have the C/E Bovine. My activities have not been restricted at all. I'm 50 years old and play full court basketball and have had my HR will over 150. I had more problems with sore muscles,because I was so out of shape. As I have said on other post, if it wasn't for the nerves in my chest area and of courses my battle scar. I wouldn't know I've had open heart surgery. I believe your body will tell you when enough is enough. I believe in this so much. That's why I'm alive today. It was because I knew my body, that I kept going back to the doctors and they finally did a Cat Scan. And guess what they found an "Aortic Aneurysm", size 6.5 cm. Anyway, I have a very aggressive doctor and he told me to do whatever I want. Actually, the only thing he cautioned me on was weight lifting.(no heavy weights).

 

[conk]

Progress

Progress

I am feeling very fortunate and want to share the possible. My recovery is going well indeed.

On Friday 10/24 another guy at work (about 14 years younger) and myself went out for a morning bike ride of about 1.5 hours. In the first part of the ride we did a 3-mile field test, which means to ride 3 miles as quick as possible. Maximum and average heart rates over the time were also recorded. A cool down period of 10-15 minutes was followed by another 3-mile filed test. Bryan did the 3 miles in a time of 7:27 and 7:14 (almost 25 mph average). As you can surmise, he is an advanced rider. My times were 9:18 and 9:17 (average of 19.4 mph). My high heart rate and average for the runs was 169/175 and 164/172. I thought this was great for this point in my recover, still 4 days before my 2 month anniversary on my second AVR. I know that the maximum heart rate on the ride if not my maximum is very close, however, I felt no adverse sensations from this effort, other than being a bit spent from the effort, which I know is normal.

On Saturday I rode 37 miles and so far this week I have done almost 3 hours on a life cycle/kinetic trainer averaging about a 140 HR. Other than not lifting weights, I'm feeling as if I hadn't gone through surgery.

Jim and Bob,
I sure hope you have the same success with your surgeries and recovery.
Regards...Conk

 

[khan2]

Exercise limitations

Exercise limitations

Conk: As a cardiologist familiar with the St. Jude valve, I am nearly certain you won't hurt your heart valve by getting your exercise heart rate up to 150 (or higher). However, the issue with exercise may have to do with the state of your heart muscle. Some patients (not all) develop damage to their heart muscle from their valve disease which may put them at risk if they exercise too strenuously. For example, if you have severe hypertrophy (thickening) of the heart muscle or if you have developed other forms of damage to the muscle (cardiomyopathy) from your leaking valve, you may be at risk for arrhythmias (irregular heart beats) or even sudden death with strenuous exercise. However, the heart can remodel back to normal over a period of time (typically 3 months or more) after valve surgery. You may want to check with your cardiologist about some of these issues. He may want you to have an echo and/or an exercise study before OKing you for very high intensity exercise. After another form of open heart surgery (CABG) patients receive 12 weeks of cardiac rehabilitation (supervised exercise) at the end of which we usually do a full Bruce protocol treadmill test to see what each patients safe exercise tolerance is.

Another option used by many competitive athletes to evaluate their fitness level is a cardiopulmonary exercise (CPX) test. If you look in some of the triathalon magazines available here in SoCal (such as Competitor), you should see ads for these. A CPX test can give you a better idea of your true fitness level as judged by your VO2max. The heart rate is really just used as a surrogate for VO2max since heart rate tends to go up linearly with VO2max. If your Cardiologist OKs you for exercise, you might consider seeing an exercise physiologist (again check ads in Competitor) and getting a training regimine/exercise prescription. Best of luck.

 

[Nancy]

Hi Dr. Steven Khan-

Just wanted to welcome you to this terrific site. We'll look forward to your posts and hope to see you here often.

My husband is the patient here, he's been through a TON of stuff.

 

[HFK]

Hi Dr Khan, Welcome to this site, many good people here. I believe there are a few doctor's aboard here and a few RN's.HFK

 

[Marty]

Welcome Dr. Khan

Welcome Dr. Khan

Dr. Kahn, That was a terrific post. We really need a cardiologist to ring in regularly. I am a semi-retired radiologist working half time for Kaiser here in Northern Virginia. I've learned a lot of cardiology
since my own surgery but can get in too deep very quickly. Hope to hear from you frequently. Marty

 

[conk]

Dr. Khan

Dr. Khan

Thanks so much for your informative post. This is great information.

"...Some patients (not all) develop damage to their heart muscle from their valve disease which may put them at risk if they exercise too strenuously. For example, if you have severe hypertrophy (thickening) of the heart muscle or if you have developed other forms of damage to the muscle (cardiomyopathy) from your leaking valve, you may be at risk for arrhythmias (irregular heart beats) or even sudden death with strenuous exercise..."

I have had two echoes since my heart surgery on 8/26. The first was 8 days after surgery and all my readings were normal and my left ventricle diastolic measurement was 6.0, down from 7.0. I had a second echo on 9/28 and all my heart measurements were within normal limits and my LV measurement had gone down to 5.4. I've had no other damage to my heart muscle, at least that I've been told about. I have a Stress Echo scheduled for 12/27, which is about 4 months after surgery. Should get a good indication about progress at that point.

"...However, the heart can remodel back to normal over a period of time (typically 3 months or more) after valve surgery..."

My Cardiologist told me that the heart had remolded back to normal parameters on the 9/28 Echo. Seems a bit fast, since this was only 1 month after my surgery.

"...Another option used by many competitive athletes to evaluate their fitness level is a cardiopulmonary exercise (CPX) test..."

I will look into the CPX test. I've had one run in the past, about 6 years ago and still have the records, so will be very interested to see how I would compare now that I have a new (mechanical) valve. I understand the hemodynamics are not as good as a human valve, but the St. Jude's Regent seems to have the best of any mechanical from the information I've gathered. I will probably do this test after my echo in December.

Thanks again for all the good info.

Regards...Conk

 

[conk]

Dr. Khan

Dr. Khan

I wanted to ask about your comment in terms of intense exercise not being a problem if I didn't have the problems that you mentioned.

The only real concern that I have is that my heart muscle be fully healed such that I'm not subjecting the heart and/or valve area to pressures they are not ready to handle a little over 2 months after surgery.

How long in an optimum recovery does it take for the stitches around the valve to be able to hold up?

Do the stitches disintegrate over time or are they permanent?

Is there ever a problem where the valve could come loose from its location?

Two years after surgery, what holds the valve in position?

I appreciate your input on these questions.

Regards?Conk

 

[khan2]

Conk wrote:
"The only real concern that I have is that my heart muscle be fully healed such that I'm not subjecting the heart and/or valve area to pressures they are not ready to handle a little over 2 months after surgery."

"How long in an optimum recovery does it take for the stitches around the valve to be able to hold up?" For all practical purposes, the stitches will hold up right away, assuming the surgeon has tied it in properly. As tissue grows in over 2-3 weeks the bond gets stronger and the seal tighter. There may be very small leaks back through the valve in the first couple days after surgery but these usually seal within days. In 16 years and over 2,500 valve implants, (13,000 patient years*) , I don't think I've ever seen an aortic valve tear out without a serious infection. Rarely, a valve can come partially loose (dehisce) related to technical surgical issues (not enough sutures!). This usually results in a leak around the valve. Although this is usually seen with new or inexperienced valve surgeons, it does occasionally happen to very good surgeons. We recently operated on a patient who was 3 years out from his AVR at a very prominent LA academic institution who had a leak around his valve that had probably been there the entire time from his original surgery.

Do the stitches disintegrate over time or are they permanent?
They are permanent. Look at the photo of the explanted Starr-Edwards valve on this forum from a patient who had his valve about 20 years ago. You'll see the stitches completely intact on the valve ring after 20 years!

Is there ever a problem where the valve could come loose from its location?
Thankfully, most valve surgeons are good at tying knots these days! So pretty much the only reason a valve would come loose late after surgery is an infection (endocarditis). I do remember one case we had of a patient with a St. Jude aortic valve infection where the valve ring was completely encased in pus. When the surgeon opened the aorta, the valve could easliy be just lifted out with a forceps without cutting any sutures. Scary!

Two years after surgery, what holds the valve in position?
The sutures do and the fibrous tissue that has grown into the fabric of the sewing ring. This tissue ingrowth was an problem for the St. Jude Silzone valve** which had a sewing ring covered with a new silver based coating. The silver coating was designed to reduce infection by preventing bacteria from getting into the cloth ring. However, the coating also prevented the fibrous tissue from growing into the ring and they had some late valve leaks. The valve was taken off the market subsequently.

*Twenty-year comparison of tissue and mechanical valve replacement. Khan SS, Trento A, et al. J Thorac Cardiovasc Surg. 2001 Aug;122(2):257-69. Divisions of Cardiology and Cardiothoracic Surgery, The Cedars-Sinai Medical Center Burns & Allen Research Institute, University of California at Los Angeles School of Medicine

** Paravalvular leak and other events in silzone-coated mechanical heart valves: a report from AVERT. Ann Thorac Surg. 2002 Mar;73(3):785-92.

 

[khan2]

Just to clarify my last post, leaks around the Silzone valve were rare (<5% of patients) and they appeared early after the valve was put in. If you've had a Silzone valve, are doing fine, and have had an echo after surgery that showed no leak, you have nothing to worry about.

 

[conk]

Thanks for the response!!!

Thanks for the response!!!

Dr. Kahn,

Your thorough response is much appreciated. I believe in probably one month I will be in better condition than prior to my first surgery. I had no obvious symptoms before the first surgery, but I did not seem to have as much aerobic capacity as expected over an extended bike ride.

It's good to know I don't have to worry about the valve coming loose.

Thanks again....Denis

 

[conk]

5+ Months after AVR Cycling Report

5+ Months after AVR Cycling Report

300 mile Bike Ride - Carmel to Camarillo

Just an update on my progress and for those who are concerned about intense excercise post surgery. On Superbowl weekend, I joined 4 others for a 3-day back to back century.

This was not a sponsored ride, but some of the group have been doing this ride for the past 8 years as part of early year training. The other riders in the group have been riding far longer than I, but I had completed a 72 mile ride as part of a 145 mile week, just two weeks prior, so thought I might be up to the challenge. Even though I was suffering a bit (any one who has riden long distance on a bike know what I mean), it was a great time and I completed the entire ride.

Some statistics follow:
DAY 1: Carmel, CA to Cambria, CA on the Pacific Coast Hiway
Max HR-164, Avg HR-145, Distance-96.6 miles, Total Ascent-6,400 ft, Avg Speed-16.9 mph

DAY 2: Cabria, CA to Buellton, CA on PCH, 101 & Other roads
Max HR-160, Avg HR-137, Distance-106.2 miles, Total Ascent-4,000 ft, Avg Speed-18.4 mph

DAY 3: Buelton, CA to Camarillo, CA on 101 & Other roads
Max HR-167, Avg HR-138, Distance-94.9 miles, Total Ascent-2,400 feet, Avg Speed-17.8 mph

I have in the past 3 months riden to a probably near max HR of 175, but for such a long ride, one must conserve enough energy to complete the day.

Here is a picture of the group. Questions welcome.

 

[Rush20]

Nice Pics Conk! Glad to see another avid biker in the group. Prior to my AVR on 8/29/03, my exercise regime consisted of four basic activities (1) road cycling - about 100 miles per week in season, (2) 12-inch softball two nights per week, plus occassional tourney, (3) weight training twice per week summer and four times per week winter and (4) golf - mostly social and business.

After my surgery, I too was very skeptical as to how soon and to what intensity I could resume those activities. While lying in the hospital bed, the idea of performing a bench press seemed very remote.

Now, as I close in on my 6-month anniversary, I have resumed my weight and cardio training to almost 70% of my pre-surgery intensity.

As with any "life-changing" event, what I have gained is a better appreciation for what makes my body work and the delicate balance of moderation. My weight lifting is now focused on better form and less weight moved per exercise, however more weight moved per session. Although my indoor cardio routine centers around my treadmill, I'm starting to chomp at the bit for my cycling season to start in about 6 weeks. (I live in the Chicago area so my cycling season is mid-March through mid-November with an occassional winter ride). Due to my surgery in late August, last year was the first fall riding season (my favorite) that I missed in 20 years. That probably added to my post-surgery funk.

After completing my 12-week Phase II rehab the week of Christmas, I purchased a heart monitor to help with my workouts. It's amazing the difference between aorobic and anaorobic exercise and the effects on your heart. While performing arms curls or leg presses, my HR will go from 90 at rest to 145 at the peak of the excercise. While walking/running on the treadmill, its a more gradual effect.

Lastly, thanks for asking all the questions I have wanted answered since my surgery pertaining to the valve and the effects of the heart muscle, etc. Thanks to Dr. Kahn for his thorough responses.

BTW - What kind of bike do you ride? I have a three-year old Trek 2500. Love it! My only planned cycling change post-operation is that I plan to ride the trails more vs. the open road due to the coumadin.