Aortic Valve Replacement and Whole Body Vibration

The aortic valve is the valve in the heart between the left ventricle and aorta. It is typically a three leafed (tricuspid) valve, but in a small population it is two leafed or bicuspid valve. Surgery to replace an aortic valve is typically performed through an open heart procedure. However, in Europe minimally invasive catheter-type surgeries are being done. In North America, these procedures are currently in clinical trials.  Aortic valves need to be replaced for several reasons, the most common being due to aortic stenosis (the valve fails to open fully) or aortic regurgitation (blood flows back into the heart due to an incomplete valve). If left untreated, these conditions can possibly lead to an enlarged heart and congestive heart failure. The most common symptom individuals experience with aortic stenosis and regurgitation is shortness of breath on exertion; however, chest pain, dizziness and fainting may also occur. Aortic valve calcification, congenital bicuspid aortic valve and other aortic valve disease may also require replacement due to damage of the heart valve leaflets. Valves used to replace diseased valves are either mechanical or biological (animal or human tissue). Mechanical valves are typically recommended for younger individuals as they do not need to be replaced as often, but they have increased risk for blood clots associated with them. For this reason individuals that receive a mechanical valve need to be placed on blood thinners throughout their life, while individuals with a biological valve require blood thinners for approximately three to six months.

The American Heart Association  recommends routine moderate physical activity for individuals with congenital heart disease as research has found it safe and beneficial. However they do caution against more intense exercise for individuals with an enlarged aorta and suggest that aerobic types of activity are safe compared to resistance training or weightlifting. This is in order to avoid an unnecessary stress on the heart due to “bearing down” or doing the valsalva maneuver during exercise. The American Heart Association also advises a consultation with a physician prior to initiating any exercise program.  One study looking at individuals with biological aortic valve replacements (pulmonary autograft) found that one year post-surgery the individuals were able to achieve both a high level of physical activity and hemodynamic performance ¹.  The study limitations include a small sample size and that all the subjects were male. It was also suggested that activities such as weightlifting should approached with caution.  Another study found no significant difference in exercise tolerance in individuals approximately two years post-operative small size aortic valve replacement compared to a control group ².   A final study showed that ten male individuals that had undergone an aortic valve replacement could tolerate a vigorous eight week exercise program without any significant complications ³. The Society of Thoracic Surgeons reports that individuals should return to preoperative condition or better following a successful valve replacement and once surgical wounds have healed there are little to no restrictions. The appropriate time to return to physical activity is dependent on several factors and is usually determined by the doctor who performed the surgery.

There is no research looking at Whole Body Vibration (WBV) as an exercise modality following aortic valve replacement.  Fresh surgical wounds and concerns with regards to blood clots are considered absolute contraindications to using WBV. Also, metal or synthetic implants are considered a relative contraindication. Therefore an individual that has had a mechanical valve or is on blood thinners due to increased risk for blood clots may not be suitable to use WBV. For this reason it is essential for an individual to discuss the use of WBV with their cardiac surgeon before incorporating it into their exercise routine. Once cleared by a doctor, an individual with an aortic valve replacement should begin using the WBV platform at a reduce intensity and duration. If an individual experiences any new symptoms the use of WBV should be discontinued immediately and symptoms should be discussed with a doctor. In general, if an individual experiences any pain, dizziness, or shortness of breath the WBV exercise should be discontinued.

References

1.       Donald B Doty, MD, Jean H Flores, RN, Frank G Yanowitz, MD, James H Oury, MD. 1999. Maximum exercise after aortic valve replacement with pulmonary autograft, Asian Cardiovascular and Thoracic Annals, 7, 37 - 39.

2.       Becassis, P., Hayot, M.,  Frapier, JM., Leclercq, F., Beck, L., Brunet, J., Arnaud, E., Prefaut, C., Chaptal, PA., Davy, JM., Messner-Pellenc, P.,  and Grolleau, R. 2000. Postoperative exercise tolerance after aortic valve replacement by small-size prosthesis, Journal of the American College of Cardiology, 36, 871 – 877.

3.       Landry F, Habel C, Desaulniers D, Dagenais GR, Moisan A, Côté L. 1984. Vigorous physical training after aortic valve replacement: analysis of 10 patients, 53, 562 – 6.

Scoop & Save Natural Health Foods

3133 Portage Ave.

Winnipeg, MB R3K 0W4

888-1967 myscoopandsave@shaw.ca