Abstract
Background: Left Ventricular Assist Device (LVAD) implantation is an optional therapy for patients with end stage heart failure. Physical rehabilitation after an LVAD implantation is beneficial for the patient's recovery. A detailed protocol for and our experience with a very early post LVAD implantation individualized physical rehabilitation is presented. Method: Twelve patients who underwent LVAD implantations between April 2010 and April 2011 were included in the study. As soon as the patients were able to walk by themselves (7-10 days post-op), they started aerobic exercise on a treadmill and on the Nustep: combining hand and leg aerobic exercise. Exercise was started at low intensity and for short intervals. The target was to increase intensity and duration. Progress was based on Both Subjective (Borg Scale) and objective (6 Minutes Walk Test: 6MWT) parameters. Results: Walking time and speed on the treadmill was increased from two 2-4 minutes intervals to one continuous 10 minutes exercise. The time and intensity on the Nustep increased from two intervals of 1-3 minutes to one continuous 16 minutes exercise and from 10-20 watts to 30 watts, respectively. An improvement was seen in the 6MWT from baseline to hospital discharge: 131 ± 91 meters to 262 ± 84 meters respectively (p<0.01) and from discharge to the first LVAD clinic visit: 251 ± 80 meters to 307 ± 88 m meters respectively (p<0.01). All patients reported improvement in carrying the 2-2.5 Kg of battery weight (from difficult to tolerable). Discussion: A very early stage rehabilitation program after LVAD implantation is feasible and may improve the functional capacity and the ability to carry the LVAD batteries of the LVAD supported patient. Larger studies are needed to determine the optimal time to start rehabilitation program post LVAD implantation.
Highlights
Heart Failure (HF) is a common disease associated with major disabilities, reduced quality of life, increased morbidity and high mortality rate [1,2,3,4]
Walking time and speed on the treadmill was increased from two 2-4 minutes intervals to one continuous 10 minutes exercise
In this study we propose a new physical rehabilitation protocol for Left Ventricular Assist Device (LVAD) supported patients and describe the results of implementing this protocol on a pilot of 12 patients undergoing LVAD implantation at our center
Summary
Heart Failure (HF) is a common disease associated with major disabilities, reduced quality of life, increased morbidity and high mortality rate [1,2,3,4]. With the advances in the mechanical circulatory support technologies, a growing group of patients with end stage HF that did not have any other therapeutic option, can benefit from implantation of a Left Ventricular Assist Device (LVAD). It is well established that with the support of an LVAD, there is general improvement in the functional capacity, quality of life and survival of patients with advanced HF. Left Ventricular Assist Device (LVAD) implantation is an optional therapy for patients with end stage heart failure. Physical rehabilitation after an LVAD implantation is beneficial for the patient's recovery. A detailed protocol for and our experience with a very early post LVAD implantation individualized physical rehabilitation is presented
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