title: Exercise blood pressure response during assisted circulatory support: comparison of the total artificial [corrected] heart with a left ventricular assist device during rehabilitation.
abstract: BACKGROUND
  The total artificial heart (TAH) consists of two implantable pneumatic pumps that replace the heart and operate at a fixed ejection rate and ejection pressure. We evaluated the blood pressure (BP) response to exercise and exercise performance in patients with a TAH compared to those with a with a continuous-flow left ventricular assist device (LVAD).
  
  
  METHODS
  We conducted a single-center, retrospective study of 37 patients who received a TAH and 12 patients implanted with an LVAD. We measured the BP response during exercise, exercise duration and change in tolerated exercise workload over an 8-week period.
  
  
  RESULTS
  In patients with a TAH, baseline BP was 120/69 ± 13/13, exercise BP was 118/72 ± 15/10 and post-exercise BP was 120/72 ± 14/12. Mean arterial BP did not change with exercise in patients with a TAH (88 ± 10 vs 88 ± 11; p = 0.8), but increased in those with an LVAD (87 ± 8 vs 95 ± 13; p < 0.001). Although the mean arterial BP (MAP) was negatively correlated with metabolic equivalents (METs) achieved during exercise, the association was not statistically significant (β = -0.1, p = 0.4). MAP correlated positively with METs achieved in patients with LVADs (MAP: β = 0.26, p = 0.04). Despite the abnormal response to exercise, patients with a TAH participated in physical therapy (median: 5 days; interquartile range [IQR] 4 to 7 days) and treadmill exercise (19 days; IQR: 13 to 35 days) early after device implantation, with increased exercise intensity and duration over time.
  
  
  CONCLUSIONS
  During circulatory support with a TAH, the BP response to exercise was blunted. However, aerobic exercise training early after device implantation was found to be safe and feasible in a supervised setting.
authors.affiliation: Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia 23298-7710, USA.
authors.forename: Harajeshwar S
authors.initials: HS
authors.lastname: Kohli
authors.forename: Justin
authors.initials: J
authors.lastname: Canada
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Tang
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Peberdy
authors.forename: Suzanne
authors.initials: S
authors.lastname: Harton
authors.forename: Maureen
authors.initials: M
authors.lastname: Flattery
authors.forename: Kelly
authors.initials: K
authors.lastname: Doolin
authors.forename: Gundars J
authors.initials: GJ
authors.lastname: Katlaps
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hess
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Kasirajan
authors.forename: Keyur B
authors.initials: KB
authors.lastname: Shah
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000534:rehabilitation*; D006352:Heart Ventricles / Q000503:physiopathology*; D006354:Heart, Artificial; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*