[Cardiac rehabilitation of patients with left ventricular assist device as "destination therapy"].
"End stage" heart failure is unresponsive to conventional pharmacological and non pharmacological treatments and has a bad prognosis either regarding survival or quality-of-life; besides cardiac transplantation is limited by organ shortage. Therefore mechanical devices have been developed, initially as "bridge to transplantation" and, more recently, as "destination therapy": definitive treatment for non-transplantable patients. In these patients instrumental evaluation, treatment and rehabilitation are not yet defined and standardized. This paper reports the initial experience realized, as a part of a regional cooperation project within Florence and Siena University Hospitals activities, with the first three male patients, aged 45 to 70 years, affected by end-stage heart failure (NYHA class IV), non-eligible to transplantation, and implanted with Jarvik Flowmaker 2000, an intraventricular axial-flow VAD generating a continuous blood flow. After clinical stabilization, patients underwent a specific evaluation and treatment purposely designed for these subjects during ICU and post-ICU stay and, subsequently, a formal cardiac rehabilitation program. Hemodynamic, bioumoral and functional parameters were recorded at the beginning, during and at the end of intensive rehabilitation program. All patients completed the program, achieving a remarkable and meaningful functional recovery, such to allow them going home, continuing with a self-activity with weekly follow-up in the Rehabilitation Center. The experience acquired by following these patients longitudinally--from the VAD implantation to hospital discharge--allowed us to develop a flow-chart divided in five phases, identifying the main clinical problems, the rehabilitative treatment goals and the useful indicators to define criteria for shift from every phase to the following one.
Fattirolli
Francesco
F
Dipartimento di Area Critica Medico Chirurgica Università di Firenze e Azienda Ospedaliero Universitaria Careggi, Firenze. francesco.fattirolli@unifi.it
Bonacchi
Massimo
M
Burgisser
Costanza
C
Cellai
Tommaso
T
Francini
Sara
S
Valente
Serafina
S
Sani
Guido
G
Gensini
Gian Franco
GF
D000203:Activities of Daily Living; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004867:Equipment Design; D006333:Heart Failure / Q000503:physiopathology / Q000534:rehabilitation* / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D015415:Biomarkers; D002317:Cardiovascular Agents