In this case study, a 33-year-old male with iron overload cardiomyopathy underwent Heartmate 3 (HM3) LVAD implantation as a bridge to recovery. We describe the physiotherapy intervention of this critically ill patient from ICU, to ward level care, outpatient physiotherapy and finally leading towards decommissioning of the LVAD. This is the first documented study of physiotherapy intervention in a HM3 LVAD patient with the aim of bridging to recovery, in Singapore.
The patient underwent LVAD implantation as a bridge to recovery. He was critically ill, immobile, and deconditioned on admission to the Intensive Care Unit (ICU). Individualised therapy was provided to the patient at all stages of recovery to maximise functional recovery. Initial stage of therapy included lung expansion, airways clearance and bed exercises to promote lung ventilation, preventing respiratory complications and delay further deconditioning. As soon as he was hemodynamically stable, the emphasis was on regaining muscle strength and mobility through progressive mobilisation, gait retraining and weightbearing exercises. Prior to returning home, the patient was progressed to light resistive exercise, education on physical activity and symptom monitoring at home, and caregiver training. Following discharge from the hospital, he continued with outpatient physiotherapy which included upper and lower limb resistance exercise, and aerobic exercise on the treadmill.
Close attention was paid to the vital signs and LVAD pump parameters (pump flow, pump speed, pulse index and power) during physiotherapy to ensure that the intervention was tolerable and safe.
After 16 months on HM3, the patient underwent a LVAD weaning protocol, which showed there was sufficient myocardial recovery via possible mechanical unloading and reverse remodelling of the heart. The patient completed a total of 39 inpatient and eight outpatient physiotherapy sessions, with improved mobility status and functional capacity. There were no adverse events reported during physiotherapy. He underwent successful decommissioning of HM3 LVAD, 17 months after initial admission and remains well and functionally independent in the community.
This case study illustrates that individualised and targeted physiotherapy in a patient identified for bridge to recovery using LVAD throughout all phases of their recovery, is important and safe to improve respiratory status, mobility and exercise capacity. Further studies are essential to determine the optimal type, dosage and intensity of physiotherapy interventions to maximise outcomes.
As this is a single case study, the results may not be comparable with, or generalised to all LVAD patients. The findings of this study suggest that physiotherapy and exercise is important and safe, and should be provided to patients who are implanted with an LVAD intended as a bridge to myocardial and functional recovery.
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