title: Cardiovascular prevention and rehabilitation for patients with ventricular assist device from exercise therapy to long-term therapy. Part II: long-term therapy.
abstract: Over the years left ventricular assist devices (VADs) have become more durable and reliable, smaller, simpler, easier to implant and more comfortable. The extensive experience now acquired shows successful hospital discharge with VAD use. We are entering an era in which long-term mechanical circulatory support will play an increasing role in the approach to end-stage heart failure (HF); at the same time, the extension of VADs into destination therapy has revealed the limitations of our understanding of these populations. This second paper on cardiovascular prevention and rehabilitation for patients with left VADs will deal with the management of patients outside the highly specialized HF centers and surgical setting, with particular focus on postoperative patient management. Outpatient management of VAD patients is time-intensive, and a multidisciplinary approach is ideal in long-term care. Although the new devices have definite advantages over the older pumps, some challenges still remain, i.e. infection, stroke, device thrombosis, gastrointestinal bleeding, recurrent HF symptomatology with or without multisystem organ failure, and occurrence of ventricular arrhythmias.
authors.affiliation: Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno (NO), Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pistono
authors.forename: Ugo
authors.initials: U
authors.lastname: Corrà
authors.forename: Marco
authors.initials: M
authors.lastname: Gnemmi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Imparato
authors.forename: Roberto
authors.initials: R
authors.lastname: Caruso
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Balestroni
authors.forename: Franco
authors.initials: F
authors.lastname: Tarro Genta
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Angelino
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Giannuzzi
mesh_terms: D000553:Ambulatory Care; D001145:Arrhythmias, Cardiac / Q000628:therapy; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005081:Exercise Therapy; D006333:Heart Failure / Q000534:rehabilitation / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D006973:Hypertension / Q000628:therapy; D010348:Patient Care Team; D010351:Patient Discharge; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right