Exercise Performance of Chronic Heart Failure Patients in the Early Period of Support by an Axial‐Flow Left Ventricular Assist Device as Destination Therapy

Compostella, Leonida; Russo, Nicola; Setzu, Tiziana; Compostella, Caterina; Bellotto, Fabio

doi:10.1111/aor.12172

Cited by 34 publications

(32 citation statements)

References 53 publications

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“…At maximum load, a mean RER of 1.11 (60.07) and a mean lactate concentration of 3.82 (61.0) mmol/L could be measured. Similarly high levels were attained in comparable studies (RER between 1.07 and 1.26 [10,13,[38][39][40]). As the peak exertion level criterion for CPET in healthy subjects, Kroidl et al (16) recommend an RER of >1.11 and an RER of >1.05 in cardiac patients.…”

Section: Cardiopulmonary Exercise Capacitysupporting

confidence: 61%

“…Table 4 summarizes the results of comparable studies which conducted a CPET shortly after LVAD implantation (90 days). In most investigations, comparably low values were recorded (10,13,25,38,39,41 remained unchanged over time at the same (low) levels (12.66 mL/kg/min after 3-6 months, 10.74 mL/kg/min after 1 year, and 11.18 mL/kg/min after more than 1 year). For comparison, patients after heart transplantation usually reach average values of 17-20 mL/kg/min (60-70% of predicted values) in the long term (45).…”

Section: Cardiopulmonary Exercise Capacitymentioning

confidence: 88%

mentioning

confidence: 95%

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Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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Adequate physical and functional performance is an important prerequisite for renewed participation and integration in self-determined private and (where appropriate) professional lives following left ventricular assist device (LVAD) implantation. During cardiac rehabilitation (CR), individually adapted exercise programs aim to increase exercise capacity and functional performance. A retrospective analysis of cardiopulmonary exercise capacity and functional performance in LVAD patients at discharge from a cardiac rehabilitation program was conducted. The results from 68 LVAD patients (59 males, 9 females; 55.9 6 11.7 years; 47 HVAD, 2 MVAD, 15 HeartMate II, 4 HeartMate 3, and 4 different implanting centers) were included in the analysis. Exercise capacity was assessed using a cardiopulmonary exercise test on a bicycle ergometer (ramp protocol; 10 W/min). The 6-min walk test was used to determine functional performance. At discharge from CR (53 6 17 days after implantation), the mean peak work load achieved was 62.2 6 19.3 W (38% of predicted values) or 0.79 6 0.25 W/kg body weight. The mean cardiopulmonary exercise capacity (relative peak oxygen uptake) was 10.6 6 5.3 mL/kg/min (37% of predicted values). The 6-min walk distance improved significantly during CR (325 6 106 to 405 6 77 m; P < 0.01). No adverse events were documented during CR. The results show that, even following LVAD implantation, cardiopulmonary exercise capacity remains considerably restricted. In contrast, functional performance, measured by the 6-min walk distance, reaches an acceptable level. Light everyday tasks seem to be realistically surmountable for patients, making discharge from inpatient rehabilitation possible. Long-term monitoring is required in order to evaluate the situation and how it develops further. Key Words: Heart failure-Left ventricular assist deviceCardiac rehabilitation-Exercise capacity-Functional performance.In the last few years, left ventricular assist devices (LVADs) have been increasingly implanted as treatment for terminal heart failure (HF). Whereas initially these systems were only used as a bridge to transplantation (BTT), today approximately half of all recipients have them implanted as the ultimate destination therapy (DT) (1).The overriding therapeutic goal of LVAD implantation is to ensure patient survival and guarantee preservation of organ function (2). However, when patients become permanently dependent on the system, a return to everyday life and restoration of an acceptable quality of life acquire crucial significance. An optimum build-up of exercise capacity and adequate functional performance is therefore very significant. Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitat...

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Section: Cardiopulmonary Exercise Capacitysupporting

confidence: 61%

Section: Cardiopulmonary Exercise Capacitymentioning

confidence: 88%

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Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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“…These patients are subject to very long periods of hospitalization, because their condition must be stable and they must be able to handle the replacement of external batteries before being discharged to home. These patients have to undergo strict medical supervision and can access the cardiovascular rehabilitation programs; the results of functional recovery are very slow but verifiable [6,[9][10][11]. The patient with L-VAD system is subject to a number of complications both during the hospital stay, and at home, in particular anemia, respiratory problems, recurrent infections in the insertion of the VAD cable, and on rare occasions, thrombosis [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device

Bordoni¹

2017

IJCAM

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“…Discharged rotary VAD patients may exhibit slightly improved exercise performance a number of months after implantation compared to unsupported chronic HF patients and are therefore more active [134]. Salamonsen and colleagues found that the larger the pump flow increase in exercise the greater the patient's exercise capacity [135].…”

Section: Exercisementioning

confidence: 99%

Automatic control of dual left ventricular assist devices as a biventricular assist device

Stevens¹

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In this thesis, we investigate automated methods for the control of rotary blood pumps in the treatment of heart failure. Heart failure is a common end-point for many forms of cardiovascular disease resulting in significant morbidity and mortality. Ventricular assist devices (VADs) are blood pumps designed to assist a failing heart and are used both to support patients whilst they are awaiting a heart transplant, or as an alternative to transplantation. Small rotary VADs can provide long-term support of the left ventricle (LVAD), right ventricle (RVAD) or both ventricles of the heart simultaneously.Unfortunately, the lack of a commercially available rotary RVAD has led to the implantation of two rotary LVADs as an ad hoc biventricular assist device (BiVAD). Clinicians currently operate such dual LVADs at a constant speed, which ensures balanced left and right pump flows for inactive patients.However, changes in levels of patient activity will lead to altered cardiac output requirements, which may disturb this balance. In turn, this can lead to undesirable events such as pulmonary venous congestion or ventricular suction. A control system that automatically adjusts pump speed with changes in the required cardiac output could alleviate such events and so offer significant benefits. However, while such physiological control systems have been investigated for single LVADs, limited work has been completed on dual LVAD control. In addition, there is no generally accepted framework for the evaluation of these systems that encompasses a broad range of patient scenarios, activity levels and heart conditions. Therefore, the primary aim of this thesis was to develop and evaluate a number of physiological control systems suitable for dual rotary LVADs.The first objective was to characterise the methods that are currently used to operate dual LVADs in the clinic. Using both in-vitro and in-vivo methods, it was shown that balanced left and right flow rates could be obtained by operating the RVAD slower than the LVAD, albeit at speeds below the manufacturer's recommendations (1400 -1800 RPM), which, according to other investigators, may adversely affect impeller washout. Operating both at the same design speed is only possible in patients with high pulmonary vascular resistance (PVR), high left ventricular contractility or high RVAD outflow cannula resistance. This thesis demonstrates that if the RVAD outflow cannula is restricted to a diameter between 6.5 and 8.1 mm, suitable steady-state haemodynamics (systemic flow rate 5 L.min -1 , MAP 90mmHg and LAP less than 25mmHg) can be achieved while maintaining impeller stability and optimal device washout. It was also established that changes in pump speed or outflow graft diameter were required to overcome elevations in pulmonary vascular resistance, thereby justifying the necessity of a physiological control system for dual LVADs.The second objective was to develop an in vitro evaluation protocol for control system testing utilising a mock circulation loop (MCL). The test...

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Exercise Performance of Chronic Heart Failure Patients in the Early Period of Support by an Axial‐Flow Left Ventricular Assist Device as Destination Therapy

Cited by 34 publications

References 53 publications

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device

Automatic control of dual left ventricular assist devices as a biventricular assist device

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