Lifting with an Aortic Graft

[EvolvingAdmin]

Greetings,

Last year I did the Starting Strength Program. It was fantastic. I took my squat from 80 to 225, my dealift to 250 etc etc. Life happened, insert excuses here, I stopped lifting. I had a chat later that year with my doctor and he informed me not to do any sets that are under 15 reps for the major compound movements. At first, I thought it was just an over abundance of caution, especially after seeing some of the Podcasts with the cardiologist. But, now I realize this wasnt something as trivial as the heart valve replacements ive had, or stents or bypasses and it does infact appear that an Aortic Graft precludes me from doing the program as written per Jonathan Sullivan

Most doctors I think would tell me to just not lift. But this doctor is decent and he works on the cutting edge of cardiovascular health. Obviously he is a busy guy and can't help me program my lifts which is why I am reaching out here.

My cardiac history as of last year.

"36 year old man with a past medical history notable for coarctation of the aorta status post subclavian flap repair as an infant, left ventricular outflow tract obstruction due to valvar and subvalvar aortic stenosis treated with Ross procedure and right ventricle to pulmonary artery conduit in 1998, pulmonary valve replacement with a 25 mm valve in 2009 and ascending aorta graft repair with 26 mm Ultramax Double Velour graft in 2009"

The ascending aorta graft repair was needed as it had grown into my sternum (Likely due to the Ross procedure), when they cracked it open to replace the valve, it literally ripped my heart open.

With the parameter of compound lifts being limited to a minimum of 15 reps, should I continue a modified starting strength program? Or would it be better to just find a different program that fits my limitations better?

Right now I am doing the below workout which I started on 4/17. It doesn't feel nearly as good as it did last year.

A)
Squats 3x15
Bench 3x10 (I figure its not as much of a risk to raise BP too much?)
Deadlift 1x15
Lat Pulldown 4x10

B)
Squats 3x15
OHP 3x15
Deadlift 1x15
Lat Pulldown 4x10

[Mark Rippetoe]

I struggle to understand the 15-rep requirement. How was this explained?

[EvolvingAdmin]

Well I told him I'd been lifting and making great progress felt amazing. He told me that he wants me to do 15 rep minimum on the compound lifts. No in depth explanation just that the Blood Pressure spikes caused by sets of 5 is going to be significantly higher than those at 15. He said doing 15 will reduce the chance of an aortic dissection. I don't think they actually know the specific tolerances for Ascending Aortic Grafts and what a set of 5 of heavy weights will raise BP to exactly. I assume its a general guideline. I believe it is reference to the percent of effort, more than a static number of reps. Its just easier to say 15 reps, than to say 60-65% of effort. (Or whatever that translates to)

Its my understanding cardiologists usually had and some still do recommend no weight lifting, but other than the 15 rep, I have no limitations.

[Mark Rippetoe]

He sounds like he knows quite a bit about the stresses encountered in barbell training. Better do as he says. After all, he is a Cardiologist.

[crete]

He sounds like he knows quite a bit about the stresses encountered in barbell training. Better do as he says. After all, he is a Cardiologist.

I have an ascending aortic graft. I’ve been training the starting strength way since 2020.I’m 58 years old ,my 1 rep numbers are 360 squat,410 deadlift, 275 bench ,175 press. I’ve been failing my reps on the lower body lifts regularly because I’m scared to grind it out.
All I think of is that graft letting go. It’s not my original equipment ,it’s only sutured in there.
My question to Rip , Dr.Sullivan and all you starting strength gym owners is would you let me and the (op) train in your gyms knowing our situations.?

[Jonathon Sullivan]

We've addressed this many times before, and perhaps we need to do an article on it...

...Or maybe not. The entire problem is that we just don't know the natural history of these lesions under heavy loading, not even in a general way. Even if we did we wouldn't know the natural history of yours, because aortic fuckery comes in all shapes and sizes. And it typically comes along with a lot of related vasculopathy and comorbidity, including comorbidities that indicate barbell training. IOW, people with aortic lesions tend to be the people who need training the most. That's most unfortunate.

So I don't know. I have had perhaps a half-a-dozen of these come to Greysteel. In all cases, I make prospective client selection carefully, based on their comorbidities, what they know about the size and location of the lesion, what corrective procedures have been tried, their current training status, and what I can only quite frankly call a certain je ne sais quoi about the individual. Then I demand both a waiver ("I understand that I am absolutely going to die from an exploding heart under the bar and there is nothing coach Sullivan, who is NOT a doctor in this place, can do to prevent it, or to meaningfully intervene once it inevitably happens") and a notarized, explicit letter from their vascular surgeon saying that they are Totally Cool with squats and deadlifts and presses.

To date, nobody has cleared these three hoops.

I wish I could be more positive. I train all kinds of clients that few others will. But I was an emergency doctor, and these lesions frequently ended up under my care; I diagnosed and treated a lot of them relative to my practice colleagues. In ER doc speak, I was a shit magnet for aortic catastrophes, and I was the go-to guy in our department for advice and lectures on same. I have had a lot of experience with these monsters, some of which still give me nightmares, and I take them very seriously.

Even if somebody did get through my three hoops, I wouldn't want to train them.

Sorry, man.

[crete]

Dr. Sullivan,
Thank you very much for responding so quickly and honestly. I knew you would tell it to me like it is and I respect you for that. I am going to take your advice and I'm stopping the heavy weight lifting, my wife wants me around and I want to be
there.

Would it be okay if I lied and added 10 pounds to my 1 rep maxes when I brag about my lifts? LOL

To Rip and all the guys on the forum your all bad asses in my book.

Later, Crete

[EvolvingAdmin]

We've addressed this many times before, and perhaps we need to do an article on it...

...Or maybe not. The entire problem is that we just don't know the natural history of these lesions under heavy loading, not even in a general way. Even if we did we wouldn't know the natural history of yours, because aortic fuckery comes in all shapes and sizes. And it typically comes along with a lot of related vasculopathy and comorbidity, including comorbidities that indicate barbell training. IOW, people with aortic lesions tend to be the people who need training the most. That's most unfortunate.

So I don't know. I have had perhaps a half-a-dozen of these come to Greysteel. In all cases, I make prospective client selection carefully, based on their comorbidities, what they know about the size and location of the lesion, what corrective procedures have been tried, their current training status, and what I can only quite frankly call a certain je ne sais quoi about the individual. Then I demand both a waiver ("I understand that I am absolutely going to die from an exploding heart under the bar and there is nothing coach Sullivan, who is NOT a doctor in this place, can do to prevent it, or to meaningfully intervene once it inevitably happens") and a notarized, explicit letter from their vascular surgeon saying that they are Totally Cool with squats and deadlifts and presses.

To date, nobody has cleared these three hoops.

I wish I could be more positive. I train all kinds of clients that few others will. But I was an emergency doctor, and these lesions frequently ended up under my care; I diagnosed and treated a lot of them relative to my practice colleagues. In ER doc speak, I was a shit magnet for aortic catastrophes, and I was the go-to guy in our department for advice and lectures on same. I have had a lot of experience with these monsters, some of which still give me nightmares, and I take them very seriously.

Even if somebody did get through my three hoops, I wouldn't want to train them.

Sorry, man.

Thank you very much for taking the time Jonathan. I think I will stick to what I'm doing. I know it wont be anywhere near as great as following the program, but, its something.

Thanks Rip, great program, I learned a ton from your book and your videos.

[crete]

Lifting light weights for reps is not doing anything but making me very sore. Anyone have any suggestions. Please help me out .
I’ve been lifting 60% of my 1 rep maxes for 3 sets of 10. Feel like shit

[Mark Rippetoe]

Lifting light weights for reps is not doing anything but making me very sore. Anyone have any suggestions. Please help me out. I’ve been lifting 60% of my 1 rep maxes for 3 sets of 10. Feel like shit.

I don't see any reason to do sets of 10 across. They don't make you any stronger than 5s with the same weight, but they do make you sore.