I’ve had a defective aortic valve all my life, and managed to participate in triathlons despite it - even finished iron distance events in 2002 (Pineman) and 2003 (IM Canada). Now my cardiologist says the valve flow is down to where it needs to be replaced, and I’m scheduled for surgery next week.
I know I’ll be on blood thinners for life, and contact sports are out. (although at age 50 I wasn’t competing in contact sports except the occasional accidental contact of mountain biking) Does anyone out there have any experience or knowledge of people being able to compete in triathlons with mechanical heart valves? Or am I being too optimistic to think I might be able to compete again? I’m not talking about winning an age group - I’ve never had that kind of talent anyway. I’d just like to be able to go out and participate, push myself to a reasonable limit, and see if I can get back to where I was before. Any information would be appreciated.
Well, I don’t really see why not. Certainly ask your Thoracic surgeon (they are often runners). Only real problem would be a bike wreck with your coumadin therapy. Make sure your protime/INR is in check (likely monthly) and go for it!
as a cardiac surgery resident i consented about 500 patients for aortic valve replacement procedures and participated in most of them.
if i would need a valve replacement at age 50, i would definitely go for a biological valve, which doesn’t need coumadin therapy. the biological valves - if implanted properly - should give you at least 15-20 years and the first re-operation usually is easy. by then (2022) the problem of anticoagulation/heart valve durability will be solved.
anyhow - if you go with the mechanical valve - you should be able to continue endurance sport (after about 3 month of recovery until your sternum is healed), but you better not crash your bike.
nobody can tell you in advance if you can do the longer distances again, as coumadin related complication might occur (hematuria, bleeding “little” injuries, muscle breakdown …)
btw - the surgery is not as bad as you might think - 100% routine work - good luck!
WHOA, Bob! Are you SURE you want to go the mechanical route? Consider the stentless and homograph options from a surgeon that is experienced with them and has good results. These don’t require anti-clotting drugs the rest of your life, and are MUCH gentler on your blood cells. There are a couple of newer mechanical valves (ONYX, for example), that seem to be much less dependent upon anticoagulation…ONYX supposedly has a database of 400-500 patients in a third world country where they are not even taking aspirin, and REPORTEDLY (better check this out…don’t take the salesman’s word on it!) no incidence of thrombus-related incidents. I wouldn’t go the mechanical route if it were me…but, I don’t know all your other issues related to your particular situation.
stentless valves could be a good option for patients with a narrow aortic root, but require a very experienced surgeon who should be implanting more than 2 of those babies per week.
on the other hand - my former boss had a record time of 54 minutes for a biological valve - from the first cut to the last stitch … i know hospitals where most apys take longer
(for non-surgeons - short OR time in cardiac surgery is associated with a significantly reduced risk for postop complications)
I’ve personally been involved in the cases of a couple of friends with AVRs. One had a homograft over 10 years ago…1 year out, he won his class in a national Judo match. Valve is still doing well with no regurge, nor stenosis…had to cut a pizza-shaped wedge out of his native aorta to make it fit right, a very good surgical decision. Geometry is 99% of the battle with implanting these, especially in regards to the reimplantation of the coronaries. Speed is good, but, technical superiority is still the goal. Use Aprotinin, meticulous de-airing (something way too many surgeons don’t pay enough attention to), and minimal handling of the aorta to minimize thrombus generation from plaques in the aorta, and a little extra time isn’t nearly as bad as it used to be. Ask Dr. Stump, neurosurgeon, and current Guru about brain injury during open heart surgery (heard about SCADS?). To quote him from a meeting in New Orleans this past week, “Apparently, brain injury is mostly caused by the surgical technique at the field, not by the pump.” Wow, what a change of tune compared to the old days. As a new surgeon, I hope you’ll take that to heart. A consortium in New England has been filming the surgery, insoundating the left and right middle cerebral arteries with m-mode doppler, and using the Somanetics on the frontal cortex. They are then able to critique every surgical move that results in emboli to the brain…it’s eye-opening to the surgeons…so much so that they change their practice on how they release the partial occluder…if they choose to still even use one. Keep your eyes open, and question everything…things have really changed the past few years…so much so that it’s hard to keep up with.
regarding the ross procedure - the aortic element of that procedure always had a good outcome - it’s the pulmonary valve that makes the problem.
you’re absolutely right - de-airing (preferably not through the brain) is crucial as is the proper handling of the aorta. i had the chance to work with a technically fantastic cardiac surgeon and over the course of approx. 3000 patients the link of short OR time and good outcome became very obvious. a factor that definitely also contributes to that is that “easy” cases (mostly young patients) usually make up a great percentage of that “fast” cases.
anyhow - unlike in most other surgical disciplines in cardiac surgery not only meticulousness is crucial but also operative speed.
No, I’m not talking about Ross, I should have said allograft, instead of homograft! My bad! Good luck in your training…it’s a hard row you’ve chosen to hoe…you have my respect.
btw - since when do residency programs start on a sunday in june??? i was signed up for coeur d’alene on june 26th and now i hear that this very likely will be my first day of work (if i match with my first choice) …
It probably won’t be the first time your racing schedule will be interrupted…neither programs nor patients have much consideration for a balanced lifestyle sometimes! I guess I hope you don’t get to do the race, if that means you get your first pick in programs. Best wishes to you either way.
I had two valves done in 1990 at the age of 46. It was emergency surgery due to a misdiagnosed case of endocarditis. Afterwards, my doctor told me to quit competing (I raced bikes and ran, and it was my general fittness that sustained me through the illness) and to keep my heart rate down. After about 10 years of trying to follow his advice, I moved and had to get a new doctor, one who worked with former athletes. I went back to competition and gave triathlon a try. With two St. Jude’s valves, I have never had a problem. I had the choice of a biologic transplant, but the thought of surgery again in the 15- 20 year window was not appealing. Of course, the promise that the mechanical valves would “last your for the rest of your life” didn’t seem to have much meaning, but it seemed to be a more reasonable choice. As an added bonus, the audible click of the mechanical valves turned out to be a real advantage playing golf. I just stand near someone trying to make a cricial putt and watch them search for the source of the sound as they try to concentrate.
In short, I have never had a problem and I am competing actively going into my third season. Good luck with the surgery and I hope to see you at a race sometime soon! Feel free to PM me and let me know how you are doing.
Please PM me with this - I’ve had the Ross Procedure done and am now competing without limitations or drugs. The Ross, IMHO, is really the way to go. However, your choice of surgeon is the key (experience with the procedure is a must), and I could perhaps give you some advice depending on where you live. If, for some reason, you must go mechanical, you owe it to yourself to research the surgeon(s) and cardiologists who will treat you, and their history of prescribing anti-coagulants (sp?), beta-blockers, etc. The meds can really destroy your lifestyle, and the long term effects they have on your other organ systems can be devastasting depending on your age and how long you’ll be taking them. Many cardiologists are experimenting with lower doses, and the newer valves help this. But hey, why take any of this crap if you don’t have to? If you qualify, and based on the fact that you’ve been monitored as your AI has progessed I’d bet you do, why not be better than new with no mechanical valves!?
I honestly believe people need to get many opinions when it comes to any valve replacement. There are many cardiologists and cardiothoracic surgeons who just aren’t used to treating patients who live the lifestyle we lead, and don’t take into consideration how you want to lead your life post-surgery. If the Ross Procedure hasn’t been presented to you as a viable alternative, it wouldn’t surprise me - I can’t tell you how many cardiologists aren’t really up to speed on the procedure - amazing. I would seriously question any doctor who doesn’t offer the Ross for an active person who qualifies for the procedure. My initial cardiologist (very well known SoCal guy) didn’t believe in the procedure based on a single patient he had when the Ross was first developed; he was vehemently opposed to me having it done, but now that he’s seen the results, he’s apologized and changed his tune.
Oh yeah, I forgot. The most important piece of advice for any patient who undergoes open heart surgery is not to sneeze for about three weeks! Trust me on this one - it is unlike any other pain you’ve ever felt. I know a woman who has experienced both natural childbirth, and the pain of sneezing with a sternum which has been sawed in two - she says the contraction pain of childbirth might last longer but is not nearly as intense as the “dreaded sneeze.”
Honestly, the post-op can be frustrating and painful, but there are two things to remember. First, you get to be sedated or unconscious for all the worst parts - your loved ones, however, have no such luxury and will have to agonize through every minute. Second, you’re in for probably the worst day of your life (date of surgery), but every day after that will get better!
JM, Arnold…yes, THE Arnold, had a Ross proceedure done, at least to the best of my recollection. He did have problems later, as the pulmonic valve is the weak point of that technique. The incidence of embolic problems with the mechanical valves USED to be quoted as 10% per year…every year…that’s a cummulative thing. That’s not very good! I think they quote better than that now, with slightly different antithrombotic drug regimens as well as some better valve designs.
Your point is well taken…you OWE it to yourself to find out all the options.
what you forgot to mention is that the ross procedure hasn’t been proved to offer any benefit in adult patients, except in children, bc. the pulmonary valve in aortic position has the ability to grow as the patient grows.
in most cases homograft degeneration will eventually (i hope not in your case!!) lead to a re operation, which is technically very difficult bc the whole heart is “scarred”.
i love the golf story!! never thought about that, but it makes perfect sense! whenever somebody will ask if you hear the clicking sound too, you just have to shake your head and say “what sound?”
you will definitly win that game!
Arnold had a problem a few days after the surgery because he decided to sneak on a stationary bike just outside of the CICU! Other than that, I don’t know any other problems he’s had since - not that there hasn’t been any - I just don’t know.
I can only speak of my experiences. I was lucky enough to find Vaugh Starnes at USC. My Ross was done in '98, and I’ve since seen many cardiologists. The last, after viewing my most recent echo, couldn’t even tell I had any type of surgery done, and lifted my shirt to see if there was really a scar present to make sure there hadn’t been a records mistake - funny moment. He said it was the cleanest surgical procedure he’d ever seen - there’s no evidence of scar tissue (not sure what that means, but it can’t be seen on an echo).
My biggest post-surgical frustration is that my maximum hr and resting hr seem to both have been effected by the surgery. My max hr is 172 (about 20 bpm lower) and my resting rose from 28 bpm to about 43-45 bpm. I guess some of it is related to age, but I’ve always thought it was related to the surgery.
i didn’t know starnes was doing ross’ …
i did some surgery rotations as a medical student at usc/la county. the navy trains their surgeons there - they know why (OT) …
