Exercise blood pressure response during assisted circulatory support: Comparison of the total artifical heart with a left ventricular assist device during rehabilitation

Kohli, Harajeshwar S.; Canada, Justin M.; Arena, Ross; Tang, Daniel; Peberdy, Mary Ann; Harton, Suzanne; Flattery, Maureen; Doolin, K.; Katlaps, Gundars; Heß, Michael; Kasirajan, Vigneshwar; Shah, Keyur B.

doi:10.1016/j.healun.2011.07.001

Cited by 32 publications

(11 citation statements)

References 19 publications

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“…Nevertheless, sequential evaluation at 6 and 12 months after HM II implantation supported consistency in exercise capacity and hemodynamics. These results support previous studies that considered hemodynamic responses at submaximum exercise and short‐term support with a HM II .…”

Section: Discussionsupporting

confidence: 91%

Exercise Hemodynamics During Extended Continuous Flow Left Ventricular Assist Device Support: The Response of Systemic Cardiovascular Parameters and Pump Performance

et al. 2013

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Patients on continuous flow left ventricular assist devices (cf-LVADs) are able to return to an active lifestyle and perform all sorts of physical activities. This study aims to evaluate exercise hemodynamics in patients with a HeartMate II cf-LVAD (HM II). Thirty (30) patients underwent a bicycle exercise test. Along with exercise capacity, systemic cardiovascular responses and pump performance were evaluated at 6 and 12 months after HM II implantation. From rest to maximum exercise, heart rate increased from 87 ± 14 to 140 ± 32 beats/minute (bpm) (P<0.01), while systolic arterial blood pressure increased from 93 ± 12 to 116 ± 21 mm Hg (P<0.01). Total cardiac output (TCO) increased from 4.1 ± 1.1 to 8.5 ± 2.8 L/min (P<0.01) while pump flow increased less, from 5.1 ± 0.7 to 6.4 ± 0.6 L/min (P<0.01). Systemic vascular resistance (SVR) decreased from 1776 ± 750 to 1013 ± 83 dynes.s/cm(5) (P<0.001) and showed the strongest correlation with TCO (r= -0.72; P<0.01). Exercise capacity was affected by older age, while blood pressure increased significantly in men compared with women. Exercise capacity remained consistent at 6 and 12 months after HM II implantation, 51% ± 13% and 52% ± 13% of predicted VO2 max for normal subjects corrected for age and gender. In conclusion, pump flow of the HM II may contribute partially to TCO during exercise, while SVR was the strongest determinant of TCO.

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Section: Discussionsupporting

confidence: 91%

Exercise Hemodynamics During Extended Continuous Flow Left Ventricular Assist Device Support: The Response of Systemic Cardiovascular Parameters and Pump Performance

et al. 2013

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“…(37–39) The FIM is a reliable tool that quantifies several domains of function including: self-care, motor control, ambulation, etc. (40) All three of these studies demonstrated gains in FIM and FIM efficiency (FIM/length of stay) (depicted in Table 3).…”

Section: Interventions To Improve Functional Statusmentioning

confidence: 99%

“…(40) All three of these studies demonstrated gains in FIM and FIM efficiency (FIM/length of stay) (depicted in Table 3). (37–39) These studies were limited by quasi-experimental design and measurement of few outcomes. However, more research efforts focusing on this discharge setting may help address concerns of a group of LVAD users at increased risk, i.e., those who cannot safely go home with a single caregiver or have increased supervision and physical activity and/or nursing care needs.…”

Section: Interventions To Improve Functional Statusmentioning

confidence: 99%

“…Complications during inpatient rehabilitation were varied but included: acute, symptomatic anemia, epistaxis, depression, and stroke. (37–39) These complications demonstrated the necessity for patient and provider education regarding signs and symptoms of complications, evaluating discharge practices and understanding the burden of the medical complexity of these patients.…”

Section: Interventions To Improve Functional Statusmentioning

confidence: 99%

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Functional Status in Left Ventricular Assist Device–Supported Patients: A Literature Review

Abshire

Himmelfarb

Russell

2014

Journal of Cardiac Failure

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The prevalence of advanced heart failure (HF) is increasing due to the aging population and improvements in HF management strategies. Left Ventricular Assist Device (LVAD) technology and management continue to advance rapidly and it is anticipated that the number of LVAD implants will increase. LVADs have been demonstrated to extend life and improve outcomes in patients with advanced HF. The purpose of this article is to review and synthesize the evidence on impact of LVAD therapy on functional status. Significant functional gains were demonstrated in patients supported by LVAD throughout the first year with most improvement in distance walked and peak oxygen consumption demonstrated in the first 6 months. Interventions to enhance exercise performance have had inconsistent effects on functional status. Poor exercise performance was associated with increased risk of adverse events. Functional status improved with LVAD therapy, though performance remained substantially reduced compared to age adjusted norms. There is tremendous need to enhance our understanding of factors influencing functional outcomes in this high-risk population.

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“…However, we have found that TAH patients demonstrate an abnormal blunting of the blood pressure response to exercise. This is in part related to the use of vasodilators to limit afterload 24 . While this could limit the amount of physical recovery, most patients go on to transplant before this is reached.…”

Section: Representative Resultsmentioning

confidence: 99%

Implantation of the Syncardia Total Artificial Heart

Tang

Shah

Hess

et al. 2014

JoVE

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With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect, aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia.

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Exercise blood pressure response during assisted circulatory support: Comparison of the total artifical heart with a left ventricular assist device during rehabilitation

Cited by 32 publications

References 19 publications

Exercise Hemodynamics During Extended Continuous Flow Left Ventricular Assist Device Support: The Response of Systemic Cardiovascular Parameters and Pump Performance

Exercise Hemodynamics During Extended Continuous Flow Left Ventricular Assist Device Support: The Response of Systemic Cardiovascular Parameters and Pump Performance

Functional Status in Left Ventricular Assist Device–Supported Patients: A Literature Review

Implantation of the Syncardia Total Artificial Heart

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