Exercise and Heart Valve Disease: Before and After Surgery

Video Transcript:

Adam Pick:  Hi everybody. It's Adam with HeartValveSurgery.com, and we're at the Endoscopic Cardiac Surgeon's Club in Northern Kentucky. I'm thrilled to be joined by Dr. Mark Gerdisch, who is the chief of cardiac surgery at Franciscan Health in Indianapolis, Indiana. Dr. Gerdisch. We have known each other for over a decade. It is great to see you again. Thanks for being with me today.

Dr. Marc Gerdisch: Thanks, Adam. Pleasure to be here.

Adam Pick: So we're here at this conference learning a lot, and we're also getting questions from patients coming in all over the world. And this one is a question we get from a lot of patients and I'm hoping you can help out. The question is, can you help me understand what I should know about exercise and heart valve disease?

Dr. Marc Gerdisch:  This is a really important question and it actually kind of resurfaces in the literature. Every five or six years we see someone kind of experimenting with evaluating patient response to exercise. So super important. I think that the first thing to be aware of is that if you have mild valve disease, there really isn't anything in the way of restrictions.

You should still pay attention to any symptoms. You should have some follow up with your physician, but mild valve disease really shouldn't prohibit you from whatever type of exercise you want to do. Caveat is that no matter what your valve pathology is, you want to avoid like massive straining, pushing hard, kind of, you know, lifting more than you should lift kind of thing, right?

So that's the one caveat that goes across the board, but the rest of it, for mild disease, you can pretty much do what you want. When you get into moderate, then you've got two camps, you've got insufficiency and stenosis. So, depending on the valve to some degree, but moderate insufficiency. With either the aortic or the mitral valve, or let's say the tricuspid valve really shouldn't restrict you much.

You should be able to do at least moderate exercise, certainly riding a bike, swimming, walking, jogging, um, resistance training, that's just not over the top. Those are all going to be fine. With moderate stenosis, for example, moderate stenosis is the aortic valve. With stress, with strain, you can elicit enough pressure and strain on the heart to kind of change what your heart's experiencing.

I think it's important for people who have moderate aortic valve stenosis to be paying attention simply to their symptoms. If you're starting to get short of breath, if you're having any chest discomfort, a little bit of dizziness, all of that needs to be brings you back to evaluation with your physician because it might turn out that the moderate is actually a little bit more than moderate.

People who have severe disease, whether it's regurgitation or stenosis, there, we have to kind of take it easy. I think still walking some biking, maybe stationary bike, that kind of thing is fine. Certainly, you can be a little bit more liberal with insufficiency, with severe insufficiency, then you can with severe stenosis, because with severe stenosis, you could literally cause your heart to have not enough blood flow to the heart muscle.

So aortic valve stenosis, that's severe. So working out hard would not be a great idea. Always connect with your healthcare provider to get some type of prescription. For your level of exercise, monitor your own symptoms, perhaps even your heart rhythm. We have all these devices that'll do that for you.

Monitor your own blood pressure, pay attention to things that we should all be paying attention to anyway. But, certainly you can continue to be active and it's important to be active because when you do have your operation, you want to be as fit as possible. We actually, as part of our protocols, we have “prehab”.

Which is basically when we meet our patients before surgery, and often it's not going be for a couple of months, if they're going to have surgery, we have them exercising. And so we want them as fit as possible before they have surgery. So it's important that people incorporate that. And it also helps your heart be healthier as well.

So incorporating physical activity while you have valve disease is important. And then tomorrow we're going to talk about what it's like after surgery, which. As you know, we've eliminated restrictions essentially, so people can go right back to exercising after surgery. So we try to make it just a little blip in their life and get them back on course.

Adam Pick: :Let's talk about that. You're giving a talk all about your enhanced recovery protocol for patients, and we've seen some of the stories of your patients successes. Can you share a little bit about some of the activities that these folks are getting back to very quickly? Yeah. So, uh, one of the.

Slides that I incorporated for the talk tomorrow because people are always like, well, what are your restrictions? And we just don't have any. So I have a slide that basically tells people that they can do things right because people don't think they can. And one of the interesting things that we experienced was, you know, I've been doing minimally invasive valve surgery for 25 years and, uh, a decade ago, we essentially were able to get rid of narcotics and let people do whatever they wanted and go back to driving and live their lives.

Immediately after a minimally invasive valve operation, we also, our length of stay got so short that sometimes people go home day two after hard valve surgery. So, but then we realized with the method that we were using to manage the sternum and people who needed to have their chest open for surgery, that we could progress toward the same results and we did.

It doesn't matter which way we do your surgery. The recovery process, the expectations, our methodology, the medications we use are all exactly the same. We have the same order set for every patient that has heart surgery with us. This has been really a, this has been a little bit of a miracle for us because folks can have sternotomy surgery and drive home if they want to.

I mean, we literally have that happen. People get there driving their car and drive home and. You know, for different people it'd be different depending on their, their comorbidities at the time of surgery. But I think when you look at all of our data, and we published this last year, the, the thing that I think is most important is that in the old days, a third of our patients would go from the hospital to some kind of extended care facility, rehab something.

So this all comers, redos, ery old people, very young people. Everybody is in that pod. And we went from one third down to 6%. So that for me is the most telling thing. You know, hospitals stay great, they're not in the hospital very long. People are in the hospital for all kinds of different things for a day or two, or three or five, whatever.

But most importantly, people want to go home and they want to go back to their normal lives. And that's really what we accomplish by doing that. And that's really what I'm going to try to drive home. For everybody tomorrow that while we are minimally invasive surgeons, we have to be able to offer people the, uh, full spectrum of recovery that can come with any approach.

Adam Pick the data I'm waiting to hear from you about this question is, you talked about the medications that you use during the process for your patients. What about the medications that you don't use? For example, for example, pain management, I think you've been on a crusade to lower the amount of opioid use. Can you talk about that?

Dr. Marc Gerdisch: So, and, and it's interesting because the, uh, the reduction in use of pain medication wasn't because we were taking pain medication away. It's because we were taking pain away. So we still had it available but people weren't using it. So, uh, if we look at our median use of narcotics around the time of surgery, and it doesn't matter which approach.

Whether I'm going through a little incision here or a larger incision here, the median use of narcotics in our program is zero. And the other thing, we recognize that the mechanics, because of the way we manage the sternum, and obviously when we do minimally invasive surgery, the mechanics of the chest were normalized so quickly that we could get people off the ventilator right away.

So our median time to extubation taking the tube, the breathing tube out of the mouth is zero. So vast majority of patients are off the ventilator leaving the operating room. Vast majority of patients don't need any narcotics and they don't go home with them either because they don't need them. That's why I said they can drive because they're not on narcotics and they're not hurting so they can go ahead and live their lives.

So yeah, we do have some, as you know, and just so people could see, we have videos of, you know, people hitting fast pitch, you know, three weeks out from surgery. But I think more importantly, just getting back to the rhythm of their normal lives and also having the assuredness that there's a durable outcome like that.

So. There's what happens in that first week? What happens in the three weeks? What happens in the three months, and then what happens in the rest of your life? And we try to balance all of those components and give people the optimal, perfect operation in a setting that gets them back to their lives as quickly as possible.

Adam Pick: Well, on behalf of your patients, on behalf of patients all over the world. In particular, Mr. Derloshon, who is just getting ready to run a half marathon, will put up a picture of him. He was a redo. He's been an inspiration to our community. That's lovely. I want to thank you and your extraordinary team, Dr. Gerdisch at Franciscan Health for everything you're doing on behalf of the patients.

Dr. Marc Gerdisch: It's our privilege.