The Rehabilitation of Patients With Advanced Heart Failure After Left Ventricular Assist Device Placement: A Narrative Review

Abstract

Because more patients with advanced heart failure are receiving a left ventricular assist device (LVAD) as destination therapy or a bridge to transplantation, there is increasing attention on functional outcomes and quality of life after LVAD implantation. Rehabilitation providers in the acute inpatient rehabilitation setting increasingly will treat patients with an LVAD and should understand the exercise physiology, medical management, rehabilitation considerations, and outcomes after rehabilitation for patients with an LVAD. The purpose of this article is to provide the physiatrist with a comprehensive understanding of the rehabilitation of patients with advanced heart failure and LVAD implantation. Changes in relevant organ system physiology and exercise physiology after LVAD are summarized. Safety of rehabilitation and program considerations for acute inpatient rehabilitation are reviewed. Recommendations for medical management and prevention of secondary complications seen in patients with an LVAD are outlined. A discussion of outcomes after acute inpatient rehabilitation, the dual diagnosis of stroke and LVAD placement, and long-term cognitive, functional, and quality-of-life outcomes after LVAD placement is presented.

Inpatient Cardiac Rehabilitation of LVAD Patients—Updated Recommendations from the Working Group of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases

“…25,38 Attention should likewise be paid to the hydration status of patients, and dehydration should be avoided. 39 During treatments, abrupt changes in position should always be avoided to prevent a rapid shift in blood volume. Excessive sweating and exaggerated torso stretching or compression should likewise be avoided to protect the driveline exit site and the pump.…”

Postoperative outcomes following rehabilitation in patients with left ventricular assist devices

“…The surgical treatment options for adults living with heart failure are increasingly becoming more common -due to the rising percentage of patients refractory to medical managementimproving survival rates in those subjects who are not candidates for heart transplantation [1]. Left ventricular assist device (LVAD) implantation has four primary indications, i) bridge to transplantation, ii) destination therapy (lifelong support), iii) bridge to myocardial recovery, iv) bridge to candidacy (temporary support) [2].…”

Cerebral blood flow responses to exercise are enhanced in left ventricular assist device patients after an exercise rehabilitation program

“…Following the aerobic exercise component, participants undertook a set of resistance exercises involving 3 lowerbody exercises (leg press, hamstring curl, and leg extension) and 3 upper-body exercises (incline bench press, lat pull down, and biceps curl) at 50%-60% of the baseline 1-repetition maximum test. Although participants commenced lower-body exercises at the outset of the exercise intervention, upper-body exercise was restricted until 12 wk post-LVAD implantation as per the clinical protocol to avoid postsurgical sternal injury (15). As a consequence, two participants avoided just the upper-body resistance exercises for the first 2 wk of training, and another missed the initial 3 wk.…”