Prehabilitation in Patients on the Waiting List for Heart Transplant Improves Postoperative Outcomes

Abstract

<h3>Purpose</h3> Frailty and poor functional capacity in advanced heart failure patients in the waiting list for heart transplantation (HT) are associated with increased morbidity and mortality. Pilot studies show short-term benefits through an exercise training program (prehabilitation) in HT candidates. We aim to investigate the efficacy of a prehabilitation program on the short and mid-term outcomes after HT <h3>Methods</h3> All patients entering the waiting list in a single centre from July 2017 to July 2021 were offered to join a prehabilitation program consisting in 2 hours/week personalized in-hospital exercise training, nutritional optimization and mindfulness sessions. Patients entering the program and reaching HT were included as Prehab-Group. Contemporaneous patients undergoing HT who did not start (or refused) the program, and those undergoing HT prior to program implementation (2014 to 2017) conformed the control group. Urgent HT and multiorgan transplants were excluded. Endpoints of study were mechanical ventilation time (MVT), intensive care unit (ICU) stay, total length of stay (LOS), postoperative complications, 30 days re-hospitalization and mortality after HT. <h3>Results</h3> 40 patients completed the program, from them 5 improved and came out of the waiting list, 1 patient worsened and received an LVAD and 31 reached HT and were included as Prehab-G. Fifty-one patients were included as controls. Baseline characteristics show no differences between groups except for longer median waiting time in the Prehab-G [191 (108-407) vs. 92 (27-260] days, p=0.003). Controls had longer MVT (37 vs. 20 hours, p=0.03), longer ICU stay [7 (5-14) vs. 5 (3-7) days, p=0.01], and total LOS [(23 (18-38) vs. 18 (16-22), p=0.008] than prehab patients. Prehab patients had lower rate of medical complications (5 vs. 2, p<0.001) and less severity of them (Comprehensive Complication Index 31 (23-41) vs 37 (30-72), p=0.003). There were no differences in surgical complications, in 30 d rehospitalisation or 90 days mortality between groups. All prehab patients except one (93.5%) were discharged home, whereas 16 (31.4%) controls required non-home discharge nursing/rehabilitation facilities (p=0.009). <h3>Conclusion</h3> Prehabilitation in patients listed for HT reduces postoperative complications and shortens mechanical ventilation time, ICU stay and total LOS with a higher rate of home discharge.