Harry's Journal

Ercan Afacan  Had 2 warnings for dizziness and syncope on the third one within 6 months 😩 this year. Before this major trauma, I was asymptomatic for 15 years. 

John Cook  I had regurgitation, but I never had any symptoms.

Maybe some occasional fatigue but that could also have been my apnea and/or anemia.

If I hadn’t given up the previous year on getting my blood pressure down on my own and asking a new doctor to prescribe me something, I never would have known I had a valve issue.

I also wouldn’t have known I had psoriatic arthritis because I didn’t have a chronic bad flare until they kicked me off naproxen to put me on lisinopril. I thought my sore tendon issues were just over exercising.

David Buchanan  Good morning. I was very lucky to have no symptoms at all.

In fact, I was doing CROSSFIT the day before surgery

I will note, however, I am part of a global trial and was selected to be operated on before symptoms began.


as a side note : I had stopped running - previously was able to run 50 plus km a week.
I certainly couldn’t get anywhere near that as the valve got worse.


However, no chest pain no hard breathing issues no blood pressure issues so fundamentally no symptoms whatsoever

Pamela Gregory  For me it came on very gradually. I knew I had a problem but it was so gradual that it just felt like getting older (which I was doing). The last couple of months at the severe mark was definitely more noticeable. I walk a lot and would say I started avoiding hills but never really had anything major

Pamela Gregory  Also, my personal decision at 55 was a biological valve. Very tough decision but praying it will last long enough for a TAVR replacement in the far off future

Harry Neumann  Thanks everyone that helps a bunch....   Ercan sound like you had some warnings that maybe were not gradual or what maybe could be described as being a short term(6 months). John it sounds like you had some warnings or symptoms. David you are the superstar, CrossFit the day before is amazing. Rose and Pamela I think your description being gradual kind thinking you are just getting older is maybe where I am. 

I think that with David's success story I will be going in as fit as possible. Not going to train for a marathon or start CrossFit but eat heart healthy diet and keep active, 10,000 + steps a day..

THANKS
Harry

Dan Fouratt  I was symptom free.  I failed a stress test 18 months after successfully passing one. My blood pressure drop as the test went on.  The testers stopped the test but I was physically able to go on.  They did an echo.  I went home the next day and did the stress test again and went through level 4 five times in a row. (My tread mill does not go higher.) About a week later I was called to have them tell me I needed a new valve.  I called a friend who is a leading cardiologist in another state and could not practice in my state. He said I could last a couple of years.  However I was ready so decided to mover forward.  like Pamela said it is a personal decision. Good luck on your decision journey.

John Cook  Harry, I think that’s a great plan.  I don’t know if my doctors skipped the, “let’s get you healthier before you need surgery” speech because I had made a whole bunch of lifestyle changes 2 years before diagnosis & had already lost 40lbs.

But I do think heart valve patients would benefit from a tailored diet and fitness program for that period between when we are diagnosed and when we need surgery. I say, “tailored,” because we all have different symptoms, different other chronic health problems, different levels of fitness, and different dietary needs.

Though I was relatively fit (though still obese) pre-surgery, I really could have used a nutritionist telling me to stop being almost completely vegan and to eat more eggs, fish, & meat because I have ridiculously low cholesterol and chronic anemia.

Eric Hanson  Aortic Stenosis,  Mine started ultimately about 28 years ago after going thru 3 month of radiation treatment on my upper torso area. That treatment damaged the heart, lungs and chest area tissue.(but cured the cancer I had)  Yearly checks and was very aware that complications from the damage could develop in heart or lung issues.  My primary noticed a slight murmur in the heart about 13 years ago. we tracked it since then, I never had any symptoms on that stenosis until mid 2024 and it really was only some increase fatigue but not alot, the symptoms did slowly progress, but was not affecting essential daily activities until this last summer where i quickly started having dizziness, shortness of breath and extreme fatigue and loss of interest in daily activities.  that was the sign it was time. 

Harry Neumann  Thanks Dan, John and Eric
Dan right now i have not seen the surgeon about my options of valve type. I will certainly ask questions and that is all thanks to this forum. If i do have a choice i am now slightly leaning to mechanical valve.

John I have been told go live your life until symptoms appear. When i asked about about a heart healthy diet i was told yes that is a good idea. When i asked about exercise i was told not to overdo it? what ever that means. Not given much info about this holding pattern that I am in...

Eric.. Thanks I think i am at the fatigue stage with no other symptoms.

Blood pressure is good 118/72 an hour ago
Heart rate is higher when moving 85-90 not strenuous exercise and ok when resting 65-75
I am on cholesterol meds (atorvastatin 40mg) and the levels are controlled
I am 6ft tall and about 185lbs so not grossly overweight.

Heart healthy diet cut the salt and processed foods and more walking my goal until surgery

Rose Madura  I believe it's old school thinking to say wait until symptoms. The symptoms are heart failure.   🤯

Harry Neumann  Rose you are speaking the truth....   I will push / suggest sooner than later at my next appointment

Dan Fouratt  Harry, Just to let you know my blood pressure was low prior to the surgery.  My blood pressure has been higher since the new valve was installed. 

David Buchanan  My decision was based on the following 

Hyperbolic decision-making is when people prioritise short-term comfort over long-term outcomes. In the valve choice, it could have pushed me toward a tissue valve because it feels easier right now—no lifelong medication and a simpler routine. But the long-term risk is high: the tissue valve would likely wear out and require another open-heart surgery later. Hyperbolic thinking discounts that future risk too heavily. I went with the mechanical valve because it avoids that second surgery and delivers the better long-term result.

Valerie Allen  At my age, 71 at the time, it was a clear cut recommendation with the peospect of TAVR in the future should I need it. So, Age.

John Cook  Ross, my choice to seek it out and find out if I was a good candidate, lifestyle & longevity statistics.

I wanted to get back to trail running. I didn’t want to risk being several miles down a trail, have a fall, & then have a bleeding issue if I was on blood thinners.

I was also concerned with Warfarin vs. Vitamin K & my diet.

Rose Madura  I was on the edge at age 59-1/2 so easily could have gone either way.  I did a lot of research and after discussing with my surgeon and my brother who is a doctor, I went with a tissue valve to avoid the blood thinners.  Tissue valves tend to last a little longer in "older" people who are not as active as say, a 30 year old.  I do walk every day and do some cardio workouts like Zumba.  They put in a 27 mm valve so it will take a TAVR if and when it wears out. So  more than likely, I won't need a second open heart surgery.  I've had the valve for 8 years with no regrets.  One surgeon on a call at the hospital said the valves are so good now that I may not need any more intervention. Time will tell.  I also have a strong faith in God so once I felt confident in my decision, I simply don't worry about it. You have to do research and then make an informed decision.  Once that decision is made, go with it and never look back.  All these questions you are asking us may be interesting but each of our bodies are different. Unless you can find someone exactly like you in every way, I think you are making a mistake if you plan to make a decision by these statistics.  My two cents.  The other big thing I always advocate for is a 2nd opinion.  I had four opinions before I made my choice.  

Fidel Martínez Ruiz  I was 75 years o. at surgery, surgeons recommended me a mitral tissue valve. Reasons : much less ictus risk, no sintrom and possibility of valve in valve procedure in 12- 15 years when it wears out or earlier in case of valve faillure. In young patients, the rule is toward mechanical, but a trend toward tissue Is growing up nowadays given the possibility of future TAVR or TMVR, above all in the first aortic placement.

Chris Germano  I went with the Edwards Resilia bio aorta valve. It's coated with
anti-calcium "stuff", to better protect against calcium buildup. It's only been around for 8 or so years, but the 8
year results show a significant reduction in calcium buildup as
compared to the older versions of bio valves. I also didn't want to
deal with blood thinners for the rest of my life, so no mechanical valve. I'll be 67 in December
and am hoping the Resilia valve will last 20 years. The resilia is
also designed to take a valve-in-valve TVAR much easier. So when I do
need another, in my late 80's... I'll go TAVR. But..... who knows what
will really happen. As long as the doctor gives his blessing, there probably
is no wrong choice for a given situation. Wishing all the best to everyone.

J Alexander Lassally  @ David - Nice point. Much of discourse in surgery choice is centered on these themes. Nice summary statement.  

Fidel Martínez Ruiz  Anyway is a dubious choice, to tell the truth I chose following the advice of my surgeons. My father had a tissue valve first and a second mechanical until he passed away and my brother had a mechanical when he had 67 and working well up to now, 12 years after.

Harry Neumann  Hello My Brothers and Sisters
Thanks David
Hyperbolic decision-making is an eloquent way of stating my thoughts. 
I am 58 yo and I do not want to revisit this again in 10 years even if the TAVR valve-in-Valve could be done on a tissue valve. The older you are the less resilient you may be to heart surgery. 
Chances are you are already on some daily medication like cholesterol or BP meds, so taking a daily blood thinner is not that big of a deal. With thinners you also have to check your INR to see if the thinner dose is correct. From what I understand with hand held testers like "CoaguChek INRange" available on amazon you can test at home. The other concern with taking thinners is bleeding and bruising so just be careful!

If we had long term data on the anti-calcium treated tissue valves that Chris speaks of would help but that is not available. 

Thanks for everyone's feed back and thoughts
Harry

David Buchanan  Here in Australia, the local blood testing company test my blood every few days and send me a text message each night to adjust my dosage. I have now bought an INR machine and once my levels are stable I will manage myself.

Harry Neumann  Hey David i am hearing the same for patients here in Canada. Get tested at a lab until stable then then test at home. It is suggested that you get the lab test quarterly just to make sure that your home machine is still calibrated correctly.....  

Darrell Malone  Hello. Did you happen to see the latest webinar regarding the Ross Procedure 

https://youtu.be/mnEwtXCJm1s?si=N5zZlAS5X7B8grAJ

Jennifer reynolds  I was 59 and the doctor recommended mechanical mitral valve because he said i would need another surgery if I went with tissue. Also, my father in law had a mechanical valve and I remember him doing very well. I absolutely did not want another surgery and with an at-home Testing device managing my INR is very easy

Fidel Martínez Ruiz  Harry, your survey is a good idea and perhaps you could take out some interesting conclusions. More responses are needed. Go for it !

David Buchanan  Harry

I had an on X valve installed six weeks ago
I am 55 years old and they told me it will last a lifetime

Besides the blood thinner issue that I’m still managing to try to stabilise I feel 100% back to normal after six weeks

The on X valve is very quiet and I cannot hear it ticking at all so fundamentally very similar to a tissue valve

You may want to take a look at the research here that was presented by my surgeon about 4 years ago 



It may give you some insight

https://youtu.be/NA_GdYko7BY

Harry Neumann  David Buchanan.  
Reading your story and going through all your journal posts is really touching and inspirational. Great to hear that you are doing well.  I as well have a bicuspid aortic valve that has severe stenosis and as time goes on and i get closer to my surgery date I may have some questions if that's ok? It has not been determined that a mechanical valve is the best but I think it may be?

Your Heart brother

Harry

JULIA LAFEAR  Hi... Im 51 year old female and had mitral valve stenosis. Had mechanical valve replacement and open heart surgery at end of May 25. I was very surprised I needed valve replacement as I had minor symptoms but very grateful to be 5 months from surgery and feeling more like myself again.

Ed Eller  67 yo male  On-x mechanical valve and Bentall procedure. Like David above, my valve is very quiet. Other doctors are surprised when I tell them its a mechanical valve because they don't hear any clicking. I have had no issues dealing with the blood thinner for 3 years now.

Doran Herritt  Harry, saw this and read your story and it was very like mine. (surprise murmur at annual physical) So i thought I'd chime in......Just went through my 10 year checkup for my Edwards Tissue Aortic replacement valve. I am part of the "Commence" study for the valve. Doing great. Feel great. Test showed good seating of valve and excellent condition. I was only 46 when I got mine. Study manager said they are seeing great results from study participants. I did tissue because I'm active and didn't want to take anti coagulants. Dr.s are steering you away from the tissue because they used to wear out faster in us young fellas. Not really the case anymore. (Although if you go mechanical it will last forever) Like my valve all the new Edwards (and other brands for that matter) have the anti calcification coating to make the valves last longer. (I'd love to get 20 years vs. the old 8-12 years) Anyway. whatever choice you make will be a good one. It becomes very personal. I am so happy I went tissue valve. 1 more thing find a hospital and a doc that does a lot of these. (thousands) Heart surgery is no time to go "average" on level of care. (US news ranks top hospitals, not sure if Canada is in there though) Dr. Bavaria did mine at Penn in Philly. He has moved onto Jefferson, But I would recommend him everyday of the week. Good luck! God's speed! Prayers!

John Hannon  Male Ross Procedure at age 26 and two bovine tissue valves at age 51.  I'm 58 now and doing well.  https://health.ucdavis.edu/news/features/heart-of-a-champion-how-john-hannon-went-from-open-heart-surgery-to-an-ironman-triathlon/2024/02

Darrell Malone  Hey Harry. I see there is a Patient Webinar: Advantages of the Ross Procedure hopefully you can attend it. Nov 13 6pm. 

Susan Bodner  I had st Judes mechanical valve placed 1990. I had our third child 1992. First women to have baby with artificial valve. Just passed 35 year mark, so glad i made that decision. Important to know your goals, your doctor,  great information. You are your best advocate

John Cook  Sorry it took me a while to dig this up.  This is an interview between Adam and my surgeon, Dr. Burke.

In the last 3 minutes, Dr. Burke talks about how he evaluates patients on pushing the upper age recommendations.  He uses a combination on age & general health as a proxy for life expectancy for patients.

https://youtu.be/XZHGqQAowiI?si=DbxLsPCEtYSHlLPN">https://youtu.be/XZHGqQAowiI?si=DbxLsPCEtYSHlLPN

John Cook  Ross at 53, male.

The patient’s lifestyle & overall health plays a roll in deciding if someone is still a Ross candidate on the upper end of the age recommendations.  If the valve is in good condition and the patient looks like they will have a good recovery, they may decide to go ahead with it.

I call it “the Goldilocks Zone”: you have to be sick enough to need the surgery but healthy enough to recover from the surgery.  People can be much older than 50 but still be in the Goldilocks Zone if the rest of their health still looks good.

Though I’m above the ‘normal’ cutoff and I am overweight, I was also averaging 3 hours per week of cardio.  While my endurance is still around 80% of what it was before surgery, I’m back to doing 3 hours of cardio a week at 5-months post-surgery.

If I hadn’t made some serious lifestyle changes 3 years ago, I might not have been a Ross candidate.  I certainly would have had a more difficult time with Rehab.

Adam Pick  Ross Procedure... 33 years of age. Have had no problems since then. On December 21, it will be 20 years with no post-op issues, no re-operations and/or no re-interventions.  That said, the Ross procedure has yielded a great result for me. Fyi, I continue to get annual echos to ensure that my valves and aorta remain in good shape. 

Harry Neumann  Still compiling a data set to see if there is an age grouping for the different types of aortic valve replacement.
Darrell you are the current winner for the Ross procedure at 55 y
Anyone else in the "the Goldilocks Zone" for the Ross

Thanks for all those that have responded so far.
With only 6 respondents this is in no means representative of of true population
There must be some mechanical valve people out there???




Extremely limited data set to draw any conclusions but hear it is


There is a clear age relation to valve type even on this extremely limited data set.

More data please
If you have responded thanks
If you have not please respond with the following

Type of valve replacement----- Age ---- Gender

Thanks

Cathleen Weed  I've had several types of surgery at this point since I've had 5 aortic valve replacements (except a mechanical valve). I did have a Ross at 23 but it only lasted 10 years until I developed a 6cm (that is huge) ascending aortic aneurysm which literally blew the valve out. I'm very lucky it didn't dissect before it was discovered. It had adhered to the back of my sternum which ended up saving me. I had to have my 3rd open heart at that point and have a bovine tissue valve placed along with a new Dacron ascending aorta through the arch (called the Bentall procedure). So BE SURE to know your potential future aneurysm risk if you are considering a Ross procedure. It seems to be part of a larger connective tissue disorder associated with bicuspid aortic valves. If your ascending aorta is dilated at all right now I wouldn't do a Ross. The surgeons do seem to be very aware of this risk now. Having said that, the donor valve which was placed at the pulmonic position when they took mine to put it in the aortic position is still doing just fine, thankfully . The right side of the heart doesn't receive the same amount of pressure.

I read that you are being advised to get a mechanical valve. You absolutely have to take those blood thinners with a mechanical valve. That's a lifestyle choice. Are you active? Would that bother you?

Harry Neumann  Wow Cathleen you have been though a lot.
The choice of valve might not be mine to make. Being 58 yo might just eliminate me from the ross procedure even though I am active. I am not a marathon runner but I do enjoy outdoor activities and I am always doing things. 

So if the ross procedure is not an option I would probably look at a mechanical valve. Mechanical valve just because or the longevity of it. Would I want to be on blood thinners and test the INR every month or so? Absolutely not! Could i get used to it and do that ? Probably! What choice would I have?  You can get a hand held coagulometer, test at home, adjust thinner dosage and stay in range.  Getting a tissue valve and repeat in all this in 10 years when it wears out? . I know the option of TAVR with a valve in valve would be on the table after the tissue valve wears out, but still that is another heart procedure and that may very well be less than 10 years

Thanks for sharing your story

Harry

Ercan Afacan  Hello Harry,
your understanding on the Ross procedure is correct. 
I was told and read the following, that the Ross procedure, if you meet all the requirements, has a better outcome than the tissue valve if no complications arise after the surgery. 
The tissue valve may only last 5 or 10 years at your age before another surgery is required.
The Ross is definitely a more complexe surgery hence must be performed at a high volume surgery center but the overall risks are similar to an aortic valve replacement procedure. 

Don’t hesitate if you have any other questions.   

Adam Pick  Hi Harry, The link above should answer all of your questions about the Ross.  Fyi, I had it done nearly 20 years. So far, I have not had any problems with either valve. The key is to finding a Ross Procedure expert.

Ercan Afacan  Adam when you say you have not had any problems, no symptoms. I am assuming you are having your yearly echo and all is stable? Waiting for my Ross procedure surgery date. Thanks again for all your support and bringing us together. 

John Cook  The long term statistics are better for Ross than they are for both bio & mechanical valves. The tradeoff is a slightly higher risk of mortality or complications during the surgery because it is a longer & more complex surgery.  Also, you need to fina a surgeon that does a lot of them.

The relocated pulmonary valve lasts longer than a bio valve and the donor valve is treated so there are no rejection issues. The donor valve does fine in the pulmonary position because it’s a lower pressure position than the aortic valve is.

One of the keys to recovery is a strict protocol to keep your blood pressure under 120 when at rest for the first year. It helps the pulmonary valve to adapt to its new home.  One of the hangups for me being discharged from the hospital was finding the right combo of carvedilol, losartan, & amlodipine to keep me under 120 but also not too low.  I’ve since had to adjust the balance twice.

Harry Neumann  Hey thanks for all the Info.

Adam thanks for the link to the Ross procedure, that really does help. Thanks for the info on the webinar Now 13 as well. And Adam a really BIG thanks for this website, it has helped me more than you can imagine

In my searching for a surgeon I did come across the following site.
https://therossprocedure.org/find-a-surgeon

Ercan it sounds like you are going through the same thing that I am. Do you have a surgery date? Where are you getting the procedure done? And who and how did they determine that you were a candidate for the ross?

John thanks for your info. You state that the long term statistics are better for the ross than they are for both the bio and mechanical valve? I can see how it could be better than the bio valve but long term the mechanical does last? It does also make sense that the donor valve would last longer or even a life time in the low pressure pulmonary position. The strict control on the BP is also something that I did not know about.

Harry

Ercan Afacan  Harry,
I do not have a date yet but I was told in 2-4 weeks. 
My surgery will be at the Montreal Heart Institute. 
I was told that I was a candidate after the angiogram results and other tests (CT scan, Thoracic X-Ray and Lung capacity/performance)

see link below from this wonderful site. 

https://youtu.be/orp_QNBh91A?si=ioH37gtFEc8YbVdo">https://youtu.be/orp_QNBh91A?si=ioH37gtFEc8YbVdo

Harry Neumann  Thanks Ercan that is very helpful with all the test that you have gone through to determine if you are a candidate. 
Who did you ask or talk to about the possibility of ross that triggered all the tests? 

Ercan Afacan  Harry, I was first scheduled for the angiogram. After the results, they mentioned that I would be a candidate for the Ross procedure. Met the surgeon the week after explaining to me the reasons to opt for the Ross. He requested to perform the remaining tests (Blood/Urine, CT Scan-X-Rays and Lung Tests). The following week I had an appointment with my Cardiologist and the Ross procedure was still on.
I also know that during operation, they might still discover an issue with my pulmonary valve and they will abort the Ross and go for a standard Aortic valve replacement. (Biological or Mechanacial).
Hope this helps. Let me know if you have any other questions.

John Cook  My understanding is they think there are 3 reasons why the long term statistics are better for Ross vs. mechanical valve:
1) the mechanical valve carries an increased risk of stroke.  That’s why warfarin is proscribed.
2) the relocated pulmonary valve will continue to grow with the patient. That’s why Ross is done on a lot of children.
3) the tissue for both valves is human and can flex the way human tissue flexes. Creep-stress can create problems for the other valves at the attachment points.

i also had to have a backup plan if they found an issue with my pulmonary valve.  I also chose a bio-valve as my backup.

Harry Neumann  At 58 yo I may not be a candidate for the ross. So I must check out my other options as well. Mechanical you have good longevity but life long testing and blood thinners...  Tissue valve you have no thinners to take but not as long lasting. 
I did come across something that is called "valve in valve" replacement for failed replacement tissue valves
So far I have not see a good reason as to why the valve in valve cannot be done on an original heart valve and only on a replaced tissue valve. If it can work on a failing tissue valve why not on the original through TVAR
Is the "valve in valve" a last resort for older people? 

Thanks
Harry

Cathleen Weed  Hi Harry - I am doing a copy/paste of my answer above to your other question...


I also want to add (based on this question) that they are starting to do a bunch of research on TAVR success being done into a native bicuspid aortic valve. They are done now but the risks are higher. Cedars Sinai just received I believe a $26 million grant to study this very thing. You

I've had several types of surgery at this point since I've had 5 aortic valve replacements (except a mechanical valve). I did have a Ross at 23 but it only lasted 10 years until I developed a 6cm (that is huge) ascending aortic aneurysm which literally blew the valve out. I'm very lucky it didn't dissect before it was discovered. It had adhered to the back of my sternum which ended up saving me. I had to have my 3rd open heart at that point and have a bovine tissue valve placed along with a new Dacron ascending aorta through the arch (called the Bentall procedure). So BE SURE to know your potential future aneurysm risk if you are considering a Ross procedure. It seems to be part of a larger connective tissue disorder associated with bicuspid aortic valves. If your ascending aorta is dilated at all right now I wouldn't do a Ross. The surgeons do seem to be very aware of this risk now. Having said that, the donor valve which was placed at the pulmonic position when they took mine to put it in the aortic position is still doing just fine, thankfully . The right side of the heart doesn't receive the same amount of pressure.

I read that you are being advised to get a mechanical valve. You absolutely have to take those blood thinners with a mechanical valve. So that's a lifestyle choice. Are you active? Would that bother you?

Ercan Afacan  Hello Harry. 

Since I have a bicuspid aortic valve, I can chime in. 

1-Left ventricule hypertrophy. Your left heart muscles are working harder than normal to pump the blood through the aortic valve hence its getting bigger.

2-EF > 60% is normal. That is the % of the blood the left ventricule pumps each  beat. 


3- Yes the comment here is that they cannot determine the number of leaflets on your aortic valve due the the calcifications. You mentioned that you were diagnosed with having a  bicuspid aortic valve. 

Hope it helps. Let me know if you have  any questions. Happy to help out as I have been reading up on this ever since I was told that I would need surgery. 

Harry Neumann  Thanks Ercan
The cardiologist did say probably Bicuspid valve, and indicated that it is genetic and that one of my parents have a bicuspid valve as well ? 
Thanks

Rose Madura  I had a bicuspid valve which was damaged from having rheumatic fever as a child. So it was kind of deformed and they never could say how many leaflets were on it. I didn't really know it was bicuspid until after surgery.  

J Alexander Lassally  Harry - as a general statement, you will get as much out of recovery as you put in and some of us get to 100% of self, some 90%, some a different percent. It all depends on many factors... I won't use rose colored glasses like many will on here (will let others do that)... 

In theory, you can become more fit and run faster, higher and stronger if you work for it. Cardiac rehab won't give you that immediately, it is just a framework. You have to do the work over time and bring motivation.  


I will say you need to pack patience and humility and give yourself time to get back to your Harry 100% whatever that looks like...

 
And yes, there are strict things you cannot do post sternotomy, but after the prescribed time period most things are theoretically attainable.  

Richard Munson  Jal, i always enjoy your comments. They are always right on point. I could toss in, not sure what fully recovered is, probably different for different people, activities to avoid might mean lifting very heavy weights. When changing a tire always use a jack. For sure differences in the bedroom. Sleeping on your back is usually better. 

Bonnie Stone-Hope  Hello Harry, I have heard very good things about cardiac rehab, but did not go myself.  This is because after both OHS, the weather was extremely bad, cold icy winter conditions, as winters in Canada are, so I stayed at home rather than risk falling.  Did stairs at home, walked inside the house, slowly increased pace, endurance.  Best of luck with your surgery

Fidel Martínez Ruiz  Hey Harry, adding my own experience to the fellows here, in my case I would tell you that I´ve recovered myself about 90% from my former physical endurance. Wish you the best !

J Alexander Lassally  Thanks for being honest Fidel - I am also probably around 85 to 90%. I was asymptomatic beforehand ... Interesting because two things can be true at once, I am more fit than ever and can run further, but also not 100% of compared to October 2023.   ( Off the record, some guys seem to lie about being 100% - maybe lie to themselves or to appear in control...) 

John Cook  I’m 5 weeks shy of 6 months, I finished rehab last week.

For everything but running, I’ve been at 100% since Week 10.  For running, I’m still around 75%. I lost a lot of endurance from the surgery. I’ve heard that stenosis patients have quicker recovery than dilation patients.  Stenosis patients develop a stronger heart from their condition and come out of surgery with a bigger pipe to pump through.  Dilation patients develop a weaker heart from their condition and come out of surgery with smaller pipe to pump through.

I just had my last follow-up with my cardiologist for 6 months. The only activity restriction I have is not pushing myself into RPEs 8 - 10 when I run. I’m not ready to push myself that hard anyway. I’m fine doing a bunch of RPE 4 - 6 runs and rebuilding my aerobic endurance for a while.

Daniel Jansen  It is Harry. It bothers some people, but for me is reassuring. It's not like it is super annoying or anything. Sometimes you forget its there, but if you listen, you will hear it. (At least I can in my case.) 

Dan Fouratt  Harry,  When we find out we need OHS fear is the first thought (maybe
second, third and fourth).  Let's be thankful we are not in an ambulance
learning this.  We have time.  Research your options. Look in to the Ross procedure.  Find out if the mechanical valve is right for you.  I was 63 when I went under the knife and I went for the tissue valve. That was my second major procedure in 6 months (brain tumor the other). Through those two I learned that you need to be your own advocate, ask questions and do the home work.  There is well north of 100,000 of these done a year so we are not alone.  Good Luck on your journey. Dan