Gillet A.1, Lamotte M.1, Chimenti S.2, Antoine M.1
1Erasmus Hospital and Free University of Brussels, Brussels, Belgium, 2Université Libre de Bruxelles, Physiotherapy, Brussels, Belgium
Background: With more than 15.000 patients implanted worldwide and a survival rate of 80% at 1 year, and 59% at 5 years, left ventricular assist device (LVAD) implantation has become a valuable and lifesaving therapeutic option in medical management of heart failure patients who are refractory to other kinds of treatment. Those devices allow not only to reduce patient mortality, but also lead them to a better health status for the transplantation when, as in Belgium actually, only the “bridge to transplant” indication is recognized.
Exercise training recommendations in this population are established by The EXPERT-Flowchart (EXercise Prevention in Everyday practice and Rehabilitation Training) and actually based on Chronic Heart Failure recommendation.
Exercise training recommendations in this population are established by The EXPERT-Flowchart (EXercise Prevention in Everyday practice and Rehabilitation Training) and actually based on Chronic Heart Failure recommendation.
Purpose: More than 90 patients have been implanted in our institution, 70 have been implanted during the last 5 years with the continuous “HeartWare®” device. Unfortunately 17 of them didn't exit from the ICU. Our population is therefore composed by 52 patients. Exercise capacity variable are obtained during a maximal cardiopulmonary exercise testing (CPET). We present the results of a sub-group of patients who follow a structured rehabilitation program.
Methods: Immediate post-operative care: Mean stay in ICU is 7,6 +/-7 days, patients are discharged from the hospital after a mean of 28 +/-12 days. The physiotherapy proposed during this phase is a classical post-operative program for heart surgery patient and consist of respiratory physiotherapy, active mobilisation and ambulation. The exercise capacity (VO2p) of our patient at one month after implantation is 43 % of PV, workload is 35 % of PV (60 Watts).
The ambulatory program consists of interval training on bicycle ergometer, treadmill, rowing machine & step based on the CPET results, and different strength exercises realised progressively to 75 % of 1-RM.
Results: At 6 and 12 month, VO2p is 53 and 50% of PV. We observe a large variation between our patient in terms of VO2p : at 6 month, from 29 to 98 % of PV. An important factor that explains those differences is the participation, or not, to a rehabilitation program as illustrate on sub-group of our patient (VO2p : rehab 65 % (20 ml/Kg.min) versus no-rehab 45 % of PV VO2 (13 ml/Kg.min)).
Conclusion(s): LVAD allow the patient to recover an active life. Nevertheless, exercise capacity is severely depressed in some patient, but increase during the first 6 month. Only patient following a structured program of exercise recover significantly. Our study demonstrates the feasibility and the efficacy of exercise training in such patient.
Implications: This kind of physiotherapy represents a valuable added value in the evolution of patient in this new challenge of medicine and surgery.
Funding acknowledgements: None
Topic: Cardiorespiratory
Ethics approval: Appove by the ethics committee of Hopital Erasme Brussels Belgium
All authors, affiliations and abstracts have been published as submitted.
