Sternal Precautions After LVAD Implantation: Are We Overdoing It?

Abstract

<h3>Purpose</h3> Sternal precautions after median sternotomy for left ventricular device surgery (LVAD) restricts the use of the upper body movement for 6 weeks to ensure complete bone healing. Enforcing strict sternal precautions can prolong the rehabilitative process. Variability and absence of clearly defined sternal precautions further limits physical therapist in fully engaging the patient in therapy. The purpose of this study was to evaluate a strategy of limiting sternal precautions with early use of a platform walker. <h3>Methods</h3> 168 patients underwent an LVAD implantation between January 2018 to December 2020. One hundred and thirty-one met inclusion criteria of not being intubated or on biventricular support at the end of 1 week. These patients were divided into two groups based on use of this strategy. Group W (platform walker, n=74) included patients who started ambulating with a platform walker and group NW (no platform walker, n=57) consisted of patient who started ambulating without a platform walker. <h3>Results</h3> 78% (58/74) of W group patients reported increased confidence and engagement with physical therapy vs. 51% (30/57) of NW patients (<i>p</i>< 0.05). The average distance ambulated at the end of two weeks was 152 (StD 31) for the W group vs. 111 feet (StD 46) for the NW group (p< 0.001). No sternal dehiscence was noted in either group. Two patients in the w group (3%) and one (2%) had superficial separation of the sternal incision with no signs of infection (<i>p</i>=0.70). <h3>Conclusion</h3> A strategy of limiting the duration of sternal precautions with early use of a platform walker does not increase the incidence of sternal dehiscence or wound complication and increases early mobilization, confidence, and engagement of patients after LVAD implantation in physical therapy.