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Huang X, Shen Y, Liu Y, Zhang H. Current status and future directions in pediatric ventricular assist device. Heart Fail Rev 2024; 29:769-784. [PMID: 38530587 DOI: 10.1007/s10741-024-10396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
A ventricular assist device (VAD) is a form of mechanical circulatory support that uses a mechanical pump to partially or fully take over the function of a failed heart. In recent decades, the VAD has become a crucial option in the treatment of end-stage heart failure in adult patients. However, due to the lack of suitable devices and more complicated patient profiles, this therapeutic approach is still not widely used for pediatric populations. This article reviews the clinically available devices, adverse events, and future directions of design and implementation in pediatric VADs.
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Affiliation(s)
- Xu Huang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
| | - Yi Shen
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
| | - Yiwei Liu
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
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Welp H, Sindermann J, Dell'Aquila AM, Deschka H, Hoffmeier A, Scherer M. Economic aspects of long-term left ventricular assist device treatment for chronic heart failure. ESC Heart Fail 2024. [PMID: 38769653 DOI: 10.1002/ehf2.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/19/2023] [Accepted: 03/10/2024] [Indexed: 05/22/2024] Open
Abstract
AIMS Technological advances and the current shortage of donor organs have contributed to an increase in the number of left ventricular assist device (LVAD) implantations in patients with end-stage heart failure. Demographic change and medical progress might raise the number of these patients, resulting in a further increase in the number of LVAD implantations. The aim of this study was to evaluate the long-term costs of LVAD therapy and identify diagnoses resulting in expensive stays. METHODS AND RESULTS In this retrospective analysis of prospectively collected data, all patients after implantation of a second- or third-generation LVAD by 31 March 2022 were included. In addition to demographic and survival data, revenues and case mix points were determined for each patient. Of the 163 patients included, 75.5% were male. The mean age at LVAD implantation was 52 ± 14 years. The mean survival was 1458 ± 127 days. During follow-up, the total inpatient treatment time per patient was 70 ± 87 days. The average duration of outpatient treatment was 55.1%, based on the total duration of support. The average revenue per patient for the implant stay was $193 192.35 ± $111 801.29, for inpatient readmissions $52 068.96 ± $116 630.00, and for outpatient care $53 195.94 ± $62 363.53. CONCLUSIONS LVAD implantation in patients with end-stage heart failure leads to improved survival but a significant increase in treatment costs. Further multi-centre studies are necessary in order to be able to assess the effects of long-term LVAD treatment on the healthcare system.
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Affiliation(s)
- Henryk Welp
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
- Interdisciplinary Heart Failure Section, University Hospital of Muenster, Muenster, Germany
| | - Jürgen Sindermann
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
- Interdisciplinary Heart Failure Section, University Hospital of Muenster, Muenster, Germany
- Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital of Muenster, Muenster, Germany
| | - Angelo Maria Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Heinz Deschka
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Andreas Hoffmeier
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Mirela Scherer
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
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Marques-Sule E, Hansen D, Almenar L, Deka P, Sentandreu-Mañó T, López-Vilella R, Klompstra L, Machado FVC. What motivates heart transplantation patients to exercise and engage in physical activity? A network analysis. Eur J Cardiovasc Nurs 2024; 23:137-144. [PMID: 37200456 DOI: 10.1093/eurjcn/zvad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
AIMS After heart transplantation (HTx), increments in physical activity (PA) are strongly recommended. However, participation rates in exercise-based cardiac rehabilitation and engagement in PA are insufficient in many patients. Hence, this study aimed to explore the central factors and the interconnections among distinct types of motivation to exercise, PA, sedentary time, psychosomatic, diet, and activity limitation characteristics in post-HTx patients. METHODS AND RESULTS This is a cross-sectional study involving 133 post-HTx patients (79 men, mean age 57 ± 13 years, mean time from transplantation 55 ± 42 months) recruited from an outpatient clinic in Spain. The patients were asked to fill in questionnaires measuring self-reported PA, motivation to exercise, kinesiophobia, musculoskeletal pain, quality of sleep, depression, functional capacity, frailty, sarcopenia risk, and diet quality. Two network structures were estimated: one network including PA and one network including sedentary time as nodes. The relative importance of each node in the network structures was determined using centrality analyses. According to the strength centrality index, functional capacity and identified regulation (subtypes of motivation to exercise) are the two most central nodes of the network (strength: z-score = 1.35-1.51). Strong and direct connections emerged between frailty and PA and between sarcopenia risk and sedentary time. CONCLUSION Functional capacity and autonomous motivation to exercise are the most promising targets of interventions to improve PA levels and sedentary time in post-HTx patients. Furthermore, frailty and sarcopenia risk were found to mediate the effects of several other factors on PA and sedentary time.
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Affiliation(s)
- Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Spain
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Building A, 3590 Agoralaan, Diepenbeek, Belgium
| | - Luis Almenar
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | | | - Raquel López-Vilella
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Östergötland, Sweden
| | - Felipe V C Machado
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Building A, 3590 Agoralaan, Diepenbeek, Belgium
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Jenkins FS, Minol JP, Akar T, Yilmaz E, Immohr MB, Dalyanoglu I, Korbmacher B, Aissa J, Boeken U, Lichtenberg A, Akhyari P, Dalyanoglu H. Pectoral muscle mass is not a robust prognostic factor for survival after left ventricular assist device (LVAD) implantation. J Cardiothorac Surg 2024; 19:76. [PMID: 38336743 PMCID: PMC10858520 DOI: 10.1186/s13019-024-02547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Left ventricular assist devices (LVAD) are an established treatment for end-stage left ventricular heart failure. Parameters are needed to identify the most appropriate patients for LVADs. This study aimed to evaluate pectoral muscle mass and density as prognostic parameters. METHODS This single-center study included all patients with LVAD implantation between January 2010 and October 2017 and a preoperative chest CT scan. Pectoral muscle mass was assessed using the Pectoralis Muscle Index (PMI, surface area indexed to height, cm2/m2) and pectoral muscle density by Hounsfield Units (HU). Overall mortality was analyzed with Kaplan-Meier survival analysis and 1-year and 3-year mortality with receiver operating characteristic (ROC) curves and Cox regression models. RESULTS 57 patients (89.5% male, mean age 57.8 years) were included. 64.9% of patients had end-stage left ventricular failure due to ischemic heart disease and 35.1% due to dilated cardiomyopathy. 49.2% of patients had preoperative INTERMACS profile of 1 or 2 and 33.3% received mechanical circulatory support prior to LVAD implantation. Total mean PMI was 4.7 cm2/m2 (± 1.6), overall HU of the major pectoral muscle was 39.0 (± 14.9) and of the minor pectoral muscle 37.1 (± 16.6). Mean follow-up was 2.8 years (± 0.2). Mortality rates were 37.5% at 1 year and 48.0% at 3 years. Neither PMI nor HU were significantly associated with overall mortality at 1-year or 3-year. CONCLUSIONS The results of our study do not confirm the association between higher pectoral muscle mass and better survival after LVAD implantation previously described in the literature.
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Affiliation(s)
- Freya Sophie Jenkins
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Jan-Philipp Minol
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
- Department of Cardiac Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Tarik Akar
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Esma Yilmaz
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Moritz Benjamin Immohr
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | | | - Bernhard Korbmacher
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Joel Aissa
- Institute of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hannan Dalyanoglu
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Kitagaki K, Aoki T, Miura H, Shimada Y, Konishi H, Tsukamoto Y, Noguchi T. Depressive symptoms, right ventricular function, and muscular strength are associated with peak oxygen uptake in patients with implantable left ventricular assist devices. Artif Organs 2024; 48:166-174. [PMID: 37921338 DOI: 10.1111/aor.14672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/12/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation is among the most effective treatment options for patients with severe heart failure. Although previous studies have examined the factors related to peak oxygen uptake (peak VO2 ), they were limited by the few patients involved and their focus on medical and physical functions. Therefore, this study comprehensively examined the factors associated with peak VO2 , which is an important prognostic factor in patients with implantable LVADs. METHODS Eighty-nine patients who underwent initial LVAD implantation and were eligible for cardiopulmonary exercise testing (CPX) between May 2014 and September 2021 were included. The patients' mean age was 48 ± 12 years, and 70% were males. Based on previous studies, the cut-off was set at 12 and 14 mL/kg/min for patients taking β-blocker and those not taking β-blockers, respectively. Furthermore, factors associated with peak VO2 were examined using multivariate logistic regression analysis. RESULTS The mean time from surgery to CPX administration was 73 ± 40 days. The high group had a higher cardiac index, right ventricular stroke work index (RVSWI), and isometric knee extensor muscular strength and lower Patient Health Questionnaire-9 (PHQ-9) and B-type natriuretic peptide values than the low group. Multivariate logistic regression analysis showed that RVSWI and KEMS were positively correlated, whereas PHQ-9 was negatively associated with peak VO2 . CONCLUSION Right ventricular function, depressive symptoms, and lower limb muscular strength were associated with exercise capacity in patients with implantable LVADs.
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Affiliation(s)
- Kazufumi Kitagaki
- Faculty of Rehabilitation, Shijonawate Gakuen University, Daito, Japan
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tatsuo Aoki
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yukihiro Shimada
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Harumi Konishi
- Department of Nursing, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasumasa Tsukamoto
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Feuerstein A, Schoenrath F, Belyavskiy E, Knierim J, Friede T, Placzek M, Bach D, Pieske-Kraigher E, Herrmann-Lingen C, Westenfeld R, Roden M, Rybczynski M, Verheyen N, Dörr M, von Haehling S, Störk S, Halle M, Falk V, Pieske B, Edelmann F. Supervised exercise training in patients with advanced heart failure and left ventricular assist device: A multicentre randomized controlled trial (Ex-VAD trial). Eur J Heart Fail 2023; 25:2252-2262. [PMID: 37702315 DOI: 10.1002/ejhf.3032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/22/2023] [Accepted: 09/09/2023] [Indexed: 09/14/2023] Open
Abstract
AIMS Small studies and observations suggested that exercise training may improve peak oxygen consumption (peakVO2 ) in patients with advanced heart failure and left ventricular assist device (LVAD). We investigated whether in this patient group a supervised exercise training can improve exercise capacity. METHODS AND RESULTS In this multicentre, prospective, randomized, controlled trial, patients with stable heart failure and LVAD were randomly assigned (2:1) to 12 weeks of supervised exercise training or usual care, with 12 weeks of follow-up. The primary endpoint was the change in peakVO2 after 12 weeks (51 patients provided a power of 90% with an expected group difference in peakVO2 of 3 ml/kg/min). Secondary endpoints included changes in submaximal exercise capacity and quality of life. Among 64 patients enrolled (97% male, mean age 56 years), 54 were included in the analysis. Mean difference in the change of peakVO2 after 12 weeks was 0.826 ml/min/kg (95% confidence interval [CI] -0.37, 2.03; p = 0.183). There was a positive effect of exercise training on 6-min walk distance with a mean increase in the intervention group by 43.4 m (95% CI 16.9, 69.9; p = 0.0024), and on the Kansas City Cardiomyopathy Questionnaire physical domain score (mean 14.3, 95% CI 3.7, 24.9; p = 0.0124), both after 12 weeks. The overall adherence was high (71%), and there were no differences in adverse events between groups. CONCLUSION In patients with advanced heart failure and LVAD, 12 weeks of exercise training did not improve peakVO2 but demonstrated positive effects on submaximal exercise capacity and physical quality of life.
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Affiliation(s)
- Anna Feuerstein
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Evgeny Belyavskiy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Medizinisches Versorgungszentrum, Berlin, Germany
| | - Jan Knierim
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Paulinenkrankenhaus gGmbH, Berlin, Germany
| | - Tim Friede
- Department of Medical Statistics, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Marius Placzek
- Department of Medical Statistics, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Doris Bach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christoph Herrmann-Lingen
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Department of Endocrinology and Diabetology, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Meike Rybczynski
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephan von Haehling
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Volkmar Falk
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Burkert Pieske
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Schlöglhofer T, Gross C, Moscato F, Neumayer A, Kandioler E, Leithner D, Skoumal M, Laufer G, Wiedemann D, Schima H, Zimpfer D, Marko C. Exercise Performance and Quality of Life of Left Ventricular Assist Device Patients After Long-Term Outpatient Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2023; 43:346-353. [PMID: 37014949 DOI: 10.1097/hcr.0000000000000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
PURPOSE Exercise performance and quality of life (QoL) of left ventricular assist device (LVAD) patients improve after early cardiac rehabilitation (CR). The purpose of this study was to examine the efficacy of multiprofessional long term phase 3 outpatient CR, and whether cardiopulmonary exercise testing (CPX) and 6-min walk testing (6MWT) post-LVAD implantation predict hospital readmission. METHODS This retrospective observational cohort study included 29 LVAD patients (58.6 ± 7.7 yr, female: 13.8%, body mass index: 29.4 ± 3.3 kg/m 2 ). Functional performance tests (CPX, 6MWT, sit-to-stand test), QoL, and psychological surveys (Kansas City Cardiomyopathy Questionnaire, hospital anxiety and depression scale, and Control Convictions about Disease and Health [KKG]) were performed at baseline and at the end of CR. RESULTS The CR was initiated at a median (IQR) of 159 (130-260) d after LVAD implantation for a duration of 340 (180-363) d with 46.8 ± 23.2 trainings. The 6MWT (408.4 ± 113.3 vs 455.4 ± 115.5 m, P = .003) and sit-to-stand test (16.7 ± 6.9 vs 19.0 ± 5.3 repetitions, P = .033) improved, but relative peak oxygen uptake (V˙ o2peak : 9.4 [8.2-14.4] vs 9.3 [7.8-13.4] mL/min/kg, P = .57) did not change. Using receiver operating characteristic curve analysis, baseline V˙ o2peak values were associated with readmission 1-yr after CR onset (C-statistic = 0.88) with a cutoff value of V˙ o2peak < 9.15 mL/min/kg (100% sensitivity, 78% specificity, P < .001). The Kansas City Cardiomyopathy Questionnaire self-efficacy and knowledge (+6.3 points), QoL (+5.0 points), and social limitation (+7.1 points) demonstrated clinically important changes. In addition, the hospital anxiety and depression scale showed a significant reduction in anxiety (4.6 ± 3.2 vs 2.6 ± 2.4, P = .03). CONCLUSIONS Long-term CR is safe and LVAD outpatients showed improvement of QoL, anxiety, and submaximal exercise performance. In addition, V˙ o2peak and 6MWT have prognostic value for readmission.
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Affiliation(s)
- Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (Messrs Schlöglhofer and Neumayer and Drs Gross, Laufer, Wiedemann, Schima, Zimpfer, and Marko); Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria (Messrs Schlöglhofer and Neumayer and Drs Moscato, Schima, and Zimpfer); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Mr Schlöglhofer and Drs Moscato and Schima); Austrian Cluster for Tissue Regeneration, Vienna, Austria (Dr Moscato); and Center for Outpatient Rehabilitation Vienna, Vienna, Austria (Drs Kandioler and Skoumal and Ms Leithner)
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Masschelein E, De Smet S, Denhaerynck K, Ceulemans LJ, Monbaliu D, De Geest S. Patient-reported outcomes evaluation and assessment of facilitators and barriers to physical activity in the Transplantoux aerobic exercise intervention. PLoS One 2022; 17:e0273497. [PMID: 36288368 PMCID: PMC9605336 DOI: 10.1371/journal.pone.0273497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 08/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Transplantoux’s MVT exercise intervention prepares organ transplant recipients to cycle or hike up France’s Mont Ventoux. We aimed to assess (i) MVT’s effects on patient-reported outcomes (PROs) and (ii) perceived barriers and facilitators to physical activity. Methods Using a hybrid design, a convenience sample of transplant recipients participating in MVT (n = 47 cycling (TxCYC); n = 18 hiking (TxHIK)), matched control transplant recipients (TxCON, n = 213), and healthy MVT participants (HCON, n = 91) completed surveys to assess physical activity (IPAQ), health-related quality of life (HRQOL; SF-36 and EuroQol VAS), mental health (GHQ-12), and depressive symptomatology, anxiety, and stress (DASS-21) at baseline, then after 3, 6 (Mont Ventoux climb), 9, and 12 months. TxCYC and TxHIK participated in a 6-month intervention of individualized home-based cycling/hiking exercise and a series of supervised group training sessions. Barriers and facilitators to physical activity (Barriers and Motivators Questionnaire) were measured at 12 months. Results Regarding PROs, except for reducing TxHIK stress levels, MVT induced no substantial intervention effects. For both TxCYC and TxHIK, between-group comparisons at baseline showed that physical activity, HRQOL, mental health, depressive symptomatology and stress were similar to those of HCON. In contrast, compared to TxCYC, TxHIK, and HCON, physical activity, HRQOL and mental health were lower in TxCON. TxCON also reported greater barriers, lower facilitators, and different priority rankings concerning physical activity barriers and facilitators. Conclusion Barely any of the PROs assessed in the present study responded to Transplantoux’s MVT exercise intervention. TxCON reported distinct and unfavorable profiles regarding PROs and barriers and facilitators to physical activity. These findings can assist tailored physical activity intervention development. Trial registration Clinical trial notation: The study was approved by the University Hospitals Leuven’s Institutional Review Board (B322201523602).
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Affiliation(s)
- Evi Masschelein
- Laboratory of Exercise and Health, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Stefan De Smet
- Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Transplantoux Foundation, Leuven, Belgium
| | - Kris Denhaerynck
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Laurens J. Ceulemans
- Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Transplantoux Foundation, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- * E-mail:
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9
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Willy K, Ellermann C, Reinke F, Rath B, Wolfes J, Eckardt L, Doldi F, Wegner FK, Köbe J, Morina N. The Impact of Cardiac Devices on Patients’ Quality of Life—A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2022; 9:jcdd9080257. [PMID: 36005421 PMCID: PMC9409697 DOI: 10.3390/jcdd9080257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 12/13/2022] Open
Abstract
The implantation of cardiac devices significantly reduces morbidity and mortality in patients with cardiac arrhythmias. Arrhythmias as well as therapy delivered by the device may impact quality of life of patients concerned considerably. Therefore we aimed at conducting a systematic search and meta-analysis of trials examining the impact of the implantation of cardiac devices, namely implantable cardioverter-defibrillators (ICD), pacemakers and left-ventricular assist devices (LVAD) on quality of life. After pre-registering the trial with the PROSPERO database, we searched Medline, PsycINFO, Web of Science and the Cochrane databases for relevant publications. Study quality was assessed by two independent reviewers using standardized protocols. A total of 37 trials met our inclusion criteria. Of these, 31 trials were cohort trials while 6 trials used a randomized controlled design. We found large pre-post effect sizes for positive associations between quality of life and all types of devices. The effect sizes for LVAD, pacemaker and ICD patients were g = 1.64, g = 1.32 and g = 0.64, respectively. There was a lack of trials examining the effect of implantation on quality of life relative to control conditions. Trials assessing quality of life in patients with cardiac devices are still scarce. Yet, the existing data suggest beneficial effects of cardiac devices on quality of life. We recommend that clinical trials on cardiac devices routinely assess quality of life or other parameters of psychological well-being as a decisive study endpoint. Furthermore, improvements in psychological well-being should influence decisions about implantations of cardiac devices and be part of patient education and may impact shared decision-making.
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Affiliation(s)
- Kevin Willy
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
- Department of Psychology, University of Münster, 48149 Münster, Germany
- Correspondence: ; Tel.: +49-251-83-44949; Fax: +49-251-83-52980
| | - Christian Ellermann
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Florian Reinke
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Julian Wolfes
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Felix K. Wegner
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Nexhmedin Morina
- Department of Psychology, University of Münster, 48149 Münster, Germany
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10
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Gobbo S, Favro F, Bullo V, Cugusi L, Blasio AD, Bortoletto A, Bocalini DS, Gasperetti A, Ermolao A, Bergamin M. Muscle strength, aerobic capacity, and exercise tolerance are impaired in left ventricular assist devices recipients: A pilot study. Front Physiol 2022; 13:967817. [PMID: 36003641 PMCID: PMC9393221 DOI: 10.3389/fphys.2022.967817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Left ventricular assist devices (LVAD) are increasingly being used as a therapy for advanced heart failure, both as a bridge to heart transplant and, given the rapid advances in the LVAD’s functionality and safety, and constant lack in availability of donor organs, as long-term destination therapy. With the diffusion of such therapy, it is crucial to assess patients’ muscle strength, aerobic capacity and exercise tolerance, to improve their functional capacity. Methods: 38 LVAD recipients (33 men and five women) were included. Exercise testing including a maximal cardiopulmonary exercise test (CPET), handgrip, isometric and isokinetic strength testing of knee and ankle flexion/extension, and Romberg balance test in three conditions (eyes open, eyes closed, double task). Given the small and heterogeneous final sample size, a mostly descriptive statistical approach was chosen. Results: 12 participants were classified as “Obese” (BMI>29.9). The most common comorbidities were type II diabetes and chronic kidney disease. Only 12 participants were able to successfully complete all the assessments. CPET and isokinetic strength trials were the least tolerated tests, and the handgrip test the best tolerated. Mean VO2 peak was 12.38 ± 3.43 ml/kg/min, with 15 participants below 50% of predicted VO2 max, of which 6 below 30% VO2max. Mean handgrip strength was 30.05 ± 10.61 Kg; 25 participants were below the 25° percentile of their population’s normative reference values for handgrip strength, 10 of which were below the 5° percentile. Issues with the management of the external pack of the LVAD and its influence on the test limited the validity of the balance tests data, therefore, no solid conclusions could be drawn from them. VO2 peak did not correlate with handgrip strength or with any of the lower limb strength measures. Conclusion: LVAD recipients show greatly reduced functional capacity and tolerance to exercise and exercise testing, with low overall strength levels. As strength variables appear to be independent from VO2 peak, different lower limbs strength tests should be explored to find a tolerable alternative in this population, which is subjected to muscle wasting due to old age, reduced tissue perfusion, side effects from the pharmacological therapies, and prolonged periods of bedrest.
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Affiliation(s)
- Stefano Gobbo
- Department of Medicine, University of Padova, Padova, Italy
| | | | - Valentina Bullo
- Department of Medicine, University of Padova, Padova, Italy
- *Correspondence: Valentina Bullo,
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Di Blasio
- Department of Medicine and Sciences of Aging, G. D’Annunzio University of Chieti-Pescara, Chieti, Pescara, Italy
| | | | - Danilo Sales Bocalini
- Laboratorio de Fisiologia e Bioquimica Experimental, Centro de Educacao Fisica e Deportos, Universidade Federal do Espirito Santo (UFES), Vitoria, Brazil
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Marco Bergamin
- Department of Medicine, University of Padova, Padova, Italy
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11
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Goldberg RL, Freed KE, Klemans N, Fioretti R, Choi CW, Kilic A, Adamo L, Florido R, Sharma K, Gilotra NA, Hsu S. Angiotensin Receptor-Neprilysin Inhibition Improves Blood Pressure and Heart Failure Control in Left Ventricular Assist Device Patients. ASAIO J 2021; 67:e207-e210. [PMID: 33883502 PMCID: PMC10905643 DOI: 10.1097/mat.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Angiotensin receptor-neprilysin inhibitors (ARNIs) greatly benefit functional capacity and longevity in heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor-neprilysin inhibitors remain underutilized and unstudied, however, in left ventricular assist device (LVAD) recipients, in spite of their underlying HFrEF. In this case series, we studied the feasibility and short-term efficacy of ARNI utilization in 21 LVAD patients. Angiotensin receptor-neprilysin inhibitor initiation was successful in most, resulting in significant consolidation of blood pressure (BP) medical management and marked improvements in both functional capacity and diuretic requirements. Angiotensin receptor-neprilysin inhibitors are safe, feasible, and within a short timeframe benefit BP and heart failure control in LVAD recipients.
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Affiliation(s)
- Rachel L. Goldberg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin E. Freed
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nancy Klemans
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Fioretti
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chun W. Choi
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahmet Kilic
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luigi Adamo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roberta Florido
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nisha A. Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Hornikx M, Van Aelst L, Claessen G, Droogne W, Vörös G, Janssens S, Van Cleemput J. Exercise capacity, muscle strength and objectively measured physical activity in patients after heart transplantation. Transpl Int 2021; 34:2589-2596. [PMID: 34644421 DOI: 10.1111/tri.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/10/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
Maximal exercise capacity of patients after heart transplantation (HTX) remains limited, affecting their quality of life. Evidence on the evolution of muscle strength and physical activity (PA) post-HTX is lacking, but a prerequisite to tailor cardiac rehabilitation programmes. Forty-five consecutive patients were evaluated every 3 months during the first year post-HTX. Functional exercise capacity (Six minutes walking distance test (6MWD)), peripheral (Quadriceps strength (QF)) and respiratory (Maximal inspiratory strength (MIP)) muscle strength were evaluated. PA (number of steps (PAsteps), active time (PAactive) and sedentary time (PAsed)) was objectively measured. 6MWD, QF, MIP, PAsteps and PAactive significantly improved over time (P < 0.001). No change in PAsed was noticed (P = 0.129). Despite improvements in 6MWD and QF, results remained substantially below those of age-and gender-matched healthy subjects. One year post-HTX, 30% of patients presented with peripheral muscle weakness. Baseline levels of 6MWD and QF were significantly higher in patients with pretransplant LVAD-implantation and this difference was maintained during follow-up. cardiac rehabilitation, combining aerobic exercise training and peripheral muscle strength training, is mandatory in patients post-HTX. Inspiratory muscle training should be implemented when respiratory muscle weakness is present. Programmes improving physical activity and reducing sedentary time post-HTX are essential.
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Affiliation(s)
- Miek Hornikx
- Department of Rehabilitation Sciences, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Lucas Van Aelst
- Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Walter Droogne
- Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Gabor Vörös
- Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, Belgium
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13
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Depression and Anxiety Moderate the Relationship Between Body Image and Personal Well-being Among Patients With an Implanted Left Ventricular Assist Device. J Cardiovasc Nurs 2021; 35:149-155. [PMID: 31904690 DOI: 10.1097/jcn.0000000000000628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) support the diseased heart of patients with advanced heart failure and are used as a bridge to heart transplantation or as destination therapy for patients ineligible for heart transplantation. Body image changes, as well as anxiety and depression, are prevalent among patients with an implanted LVAD. OBJECTIVE The aim of this study was to investigate whether a relationship exists between body image and personal well-being among patients with an implanted LVAD and, if it does, whether it is moderated by anxiety and depression. METHODS In this cross-sectional correlational study, a convenience sample of 30 adult patients with an implanted LVAD (mean age, 63 ± 10; 90% male) from the outpatient facility of a tertiary medical center completed validated instruments including the Body Image Scale, Cosmetic Scale, Hospital Anxiety and Depression Scale, and Personal Well-being Index, from October 2017 to February 2018. Results were subjected to multivariate linear regression and bootstrap moderation analyses. RESULTS Eleven patients (37%) had below-average personal well-being scores, and 14 patients (47%) had below-average body image scores. Seven (23%) had either anxiety or depression, and 11 (37%) had both anxiety and depression. Body image was found to be a significant predictor of personal well-being (t = 2.16, P = .04). When anxiety and depression were present, body image (t = 2.08, P = .049), depression (t = 2.53, P = .018), and the interaction between body image and depression (t = -2.1, P = .047) were significantly associated with personal well-being. CONCLUSIONS Body image significantly predicted personal well-being among patients with an implanted LVAD. Depression alone, or depression combined with anxiety, moderated the relationships between body image and personal well-being. The current results may help to heighten healthcare providers' awareness of body image perception among patients with an implanted LVAD.
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14
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Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up. MEDICINA-LITHUANIA 2021; 57:medicina57080747. [PMID: 34440953 PMCID: PMC8398622 DOI: 10.3390/medicina57080747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 01/30/2023]
Abstract
Background and Objectives: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. Materials and Methods: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. Results: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. Conclusions: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment.
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15
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Burstein DS, Mcbride MG, Rossano JW, O'Connor MJ, Lin KY, Mascio CE, White R, Iacobellis K, Rosenthal T, Paridon SM. Increasing Pump Speed During Exercise Training Improves Exercise Capacity in Children with Ventricular Assist Devices. ASAIO J 2021; 67:449-456. [PMID: 32701623 DOI: 10.1097/mat.0000000000001231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Exercise rehabilitation during pediatric ventricular assist device (VAD) support aims to improve musculoskeletal strengthening while awaiting heart transplantation (HT). This study aimed to determine whether increasing VAD pump speed during exercise testing and training improves exercise capacity. A single-center cohort study was performed comparing changes in exercise capacity on serial cardiopulmonary exercise testing (CPET) after exercise training at a fixed VAD pump speed (historical cohort from 2014 to 2017) compared with a prospective cohort (2017-2019) who underwent increasing pump speed during exercise training. All children were supported with intracorporeal continuous-flow VAD. Four subjects (13 ± 2.8 years) were included in the historical cohort, and 6 subjects (14 ± 1.7 years) were enrolled in the prospective cohort. Ninety percent had dilated cardiomyopathy, and one had single ventricle Fontan physiology. Baseline maximal oxygen consumption (VO2) was 19 ± 6.3 ml/kg/min. After exercise training with increased pump speed, there was substantial improvement in aerobic capacity (maximal VO2 increased 42% vs. decreased 3%, respectively) and working capacity (maximal work increased 49% vs. 13%, respectively) compared with fixed pump speed. There were no adverse events reported in either the fixed or increased pump speed cohorts. Increasing VAD pump speed during exercise training results in substantial improvement in both physical working and aerobic capacity compared a fixed pump speed in children on VAD support regardless of single or biventricular ventricle physiology. Further study of a larger cohort is needed to validate these findings to improve the approach to pediatric cardiac rehabilitation in this population.
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Affiliation(s)
- Danielle S Burstein
- From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Michael G Mcbride
- From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Joseph W Rossano
- From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Kimberly Y Lin
- From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Rachel White
- From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Katherine Iacobellis
- From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Tami Rosenthal
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
| | - Stephen M Paridon
- From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
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16
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Fresiello L, Gross C, Jacobs S. Exercise physiology in left ventricular assist device patients: insights from hemodynamic simulations. Ann Cardiothorac Surg 2021; 10:339-352. [PMID: 34159115 DOI: 10.21037/acs-2020-cfmcs-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Left ventricular assist devices (LVADs) assure longer survival to patients, but exercise capacity is limited compared to normal values. Overall, LVAD patients show high wedge pressure and low cardiac output during maximal exercise, a phenomenon hinting at the need for increased LVAD support. Clinical studies investigating the hemodynamic benefits of an LVAD speed increase during exercise, ended in inhomogeneous and sometimes contradictory results. The native ventricle-LVAD interaction changes between rest and exercise, and this evolution is complex, multifactorial and patient-specific. The aim of this paper is to provide a comprehensive overview on the patient-LVAD interaction during exercise and to delineate possible therapeutic strategies for the future. A computational cardiorespiratory model was used to simulate the hemodynamics of peak bicycle exercise in LVAD patients. The simulator included the main cardiovascular and respiratory impairments commonly observed in LVAD patients, so as to represent an average hemodynamic response to exercise. In addition, other exercise responses were simulated, by tuning the chronotropic, inotropic and vascular functions, and implementing aortic regurgitation and stenosis in the simulator. These profiles were tested under different LVAD speeds and LVAD pressure-flow characteristics. Simulations output showed consistency with clinical data from the literature. The simulator allowed the working condition of the assisted ventricle at exercise to be investigated, clarifying the reasons behind the high wedge pressure and poor cardiac output observed in the clinics. Patients with poorer inotropic, chronotropic and vascular functions, are likely to benefit more from an LVAD speed increase during exercise. Similarly, for these patients, a flatter LVAD pressure-flow characteristic can assure better hemodynamic support under physical exertion. Overall, the study evidenced the need for a patient-specific approach on supporting exercise hemodynamics. In this frame, a complex simulator can constitute a valuable tool to define and test personalized speed control algorithms and strategies.
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Affiliation(s)
- Libera Fresiello
- Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium.,Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Christoph Gross
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Steven Jacobs
- Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
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17
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Felix SEA, Oerlemans MIF, Ramjankhan FZ, Muller SA, Kirkels HH, van Laake LW, Suyker WJL, Asselbergs FW, de Jonge N. One year improvement of exercise capacity in patients with mechanical circulatory support as bridge to transplantation. ESC Heart Fail 2021; 8:1796-1805. [PMID: 33710786 PMCID: PMC8120393 DOI: 10.1002/ehf2.13234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/01/2020] [Accepted: 01/19/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS Mechanical circulatory support (MCS) results in substantial improvement of prognosis and functional capacity. Currently, duration of MCS as a bridge to transplantation (BTT) is often prolonged due to shortage of donor hearts. Because long-term results of exercise capacity after MCS are largely unknown, we studied serial cardiopulmonary exercise tests (CPETs) during the first year after MCS implantation. METHODS AND RESULTS Cardiopulmonary exercise tests at 6 and 12 months after MCS implantation in BTT patients were retrospectively analysed, including clinical factors related to exercise capacity. A total of 105 MCS patients (67% male, 50 ± 12 years) underwent serial CPET at 6 and 12 months after implantation. Power (105 ± 35 to 114 ± 40 W; P ≤ 0.001) and peak VO2 per kilogram (pVO2/kg) improved significantly (16.5 ± 5.0 to 17.2 ± 5.5 mL/kg/min (P = 0.008)). Improvement in pVO2 between 6 and 12 months after LVAD implantation was not related to heart failure aetiology or haemodynamic severity prior to MCS. We identified maximal heart rate at exercise as an important factor for pVO2. Younger age and lower BMI were related to further improvement. At 12 months, 25 (24%) patients had a normal exercise capacity (Weber classification A, pVO2 > 20 mL/kg/min). CONCLUSIONS Exercise capacity (power and pVO2) increased significantly between 6 and 12 months after MCS independent of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile or heart failure aetiology. Heart rate at exercise importantly relates to exercise capacity. This long-term improvement in exercise capacity is important information for the growing group of long-term MCS patients as this is critical for the quality of life of patients.
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Affiliation(s)
- Susanne E A Felix
- Department of Cardiology, University Medical Center of Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Martinus I F Oerlemans
- Department of Cardiology, University Medical Center of Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Faiz Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - Steven A Muller
- Department of Cardiology, University Medical Center of Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | | | - Linda W van Laake
- Department of Cardiology, University Medical Center of Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Willem J L Suyker
- Department of Cardiothoracic Surgery, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center of Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.,Institute of Health Informatics and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center of Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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Strangl F, Ullrich A, Oechsle K, Bokemeyer C, Blankenberg S, Knappe D, Reichenspurner H, Bernhardt AM, Barten MJ, Rybczynski M. Assessing palliative care need in left ventricular assist device patients and heart transplant recipients. Interact Cardiovasc Thorac Surg 2020; 31:874-880. [PMID: 33155042 DOI: 10.1093/icvts/ivaa211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Palliative care (PC) has gained rising attention in a holistic treatment approach to chronic heart failure (HF). It is unclear whether there is a need for PC in left ventricular assist device (LVAD) patients or heart transplant recipients. METHODS In a cross-sectional explorative pilot study, outpatients after heart transplantation (HTx, n = 69) or LVAD implantation (n = 21) underwent screening for palliative care (PC) need and evaluation of symptom burden and psychological distress using tools that emanated from palliative cancer care. RESULTS The 'Palliative Care Screening Tool for Heart Failure Patients' revealed scores of 4.3 ± 2.2 in HTx and 6.0 ± 2.1 in LVAD patients (max. 12 points, P = 0.003), indicating the need for PC (≥5 points) in 32% of HTx and 67% of LVAD patients. Symptom burden, as assessed by MIDOS ('Minimal Documentation System for Palliative Care') scores was substantial in both groups (4.9 ± 4.7 in HTx vs 6.6 ± 5.3 in LVAD, max. 30 points, P = 0.181). 'Fatigue', 'weakness' and 'pain' were the most frequent symptoms. Using the 'Distress-Thermometer', 'clinically relevant' distress was detected in 57% of HTx and 47% of LVAD patients (P = 0.445). In the PHQ-4 ('4-Item Patient Health Questionnaire'), 45% of LVAD patients, compared to only 10% of HTx patients, reported mild symptoms of anxiety and depression. CONCLUSIONS Findings reveal substantial need for PC in LVAD patients and, to a lesser extent, in heart transplant recipients, suggesting that multi-disciplinary PC should be introduced into routine aftercare.
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Affiliation(s)
- Felix Strangl
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anneke Ullrich
- Department of Oncology, Hematology and Bone Marrow Transplantation, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorit Knappe
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herrmann Reichenspurner
- Department of Cardiac Surgery, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander M Bernhardt
- Department of Cardiac Surgery, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus J Barten
- Department of Cardiac Surgery, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Rybczynski
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
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Mirza KK, Gustafsson F. Determinants of Functional Capacity and Quality of Life After Implantation of a Durable Left Ventricular Assist Device. Card Fail Rev 2020; 6:e29. [PMID: 33133643 PMCID: PMC7592460 DOI: 10.15420/cfr.2020.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
Abstract
Continuous-flow left ventricular assist devices (LVAD) are increasingly used as destination therapy in patients with end-stage heart failure and, with recent improvements in pump design, adverse event rates are decreasing. Implanted patients experience improved survival, quality of life (QoL) and functional capacity (FC). However, improvement in FC and QoL after implantation is not unequivocal, and this has implications for patient selection and preimplantation discussions with patients and relatives. This article identifies preimplantation predictors of lack of improvement in FC and QoL after continuous-flow LVAD implantation and discusses potential mechanisms, allowing for the identification of potential factors that can be modified. In particular, the pathophysiology behind insufficient improvement in peak oxygen uptake is discussed. Data are included from 40 studies, resulting in analysis of >700 exercise tests. Mean peak oxygen uptake was 13.4 ml/kg/min (equivalent to 48% of predicted value; 259 days after implantation, range 31–1,017 days) and mean 6-minute walk test distance was 370 m (182 days after implantation, range 43–543 days). Finally, the interplay between improvement in FC and QoL is discussed.
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Affiliation(s)
- Kiran K Mirza
- Department of Cardiology, Rigshospitalet Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet Copenhagen, Denmark
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20
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Rhoades BD, Beauchamp JES, Engebretson JC, Wardell DW. Influencing factors on left ventricular assist device adaptation: A systematic review. Heart Lung 2020; 49:501-511. [DOI: 10.1016/j.hrtlng.2020.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/28/2019] [Accepted: 01/22/2020] [Indexed: 02/02/2023]
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Quality of life among patients with left ventricular assist device: Comparison of two populations. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:308-314. [PMID: 32551161 DOI: 10.5606/tgkdc.dergisi.2020.18541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate quality of life among patients with an implanted left ventricular assist device in two different populations. Methods This cross-sectional study included a total of 20 patients (15 males, 5 females; mean age 41.8±13.4 years; range, 20 to 65 years) from Turkey and 40 patients (33 males, 7 females; mean age 55.1±11.6 years; range, 21 to 76 years) from Germany who underwent left ventricular assist device implantation and reached their third month of treatment between January 2016 and August 2016. The Euro Quality of Life-5 Dimension Questionnaire and Kansas City Cardiomyopathy Questionnaire-12 were used to assess quality of life of both groups. Results Sixty-five percent of the German patients returned to work, while none of the Turkish patients returned after implantation (p=0.000). The Turkish (70%) and German (40%) patients reported that they had difficulty in living with a left ventricular assist device (p=0.028). The mean Euro Quality of Life-5 Dimension Questionnaire visual analog scale scores of the Turkish and German patients were 70.50% and 62.38%, respectively. The mean Kansas City Cardiomyopathy Questionnaire-12 scores of the Turkish patients were significantly higher than those of the German patients (p=0.01). Conclusion Left ventricular assist device implantation improved the quality of life of both Turkish and German patients. Turkish patients with left ventricular assist device should be encouraged to adopt a more independent life, not to limit their lives to home and to return to work according to their functional capacity.
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A Comparative Content Analysis of Digital Channels for Ventricular Assist Device Patients, Caregivers, and Healthcare Practitioners. ASAIO J 2020; 65:855-863. [PMID: 30575626 DOI: 10.1097/mat.0000000000000924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article seeks to review and analyze the emergence of digital channels designed for ventricular assist device (VAD) patients, caregivers, and practitioners and to understand how such digital channels support the user experience of VAD implantation. Following a content analysis methodology, the authors investigated 16 digital channels designed for VAD patients, caregivers, and practitioners, with data being analyzed thematically. Competitor Positioning Matrix diagrams were created to visually represent the landscape of digital channels that support VAD stakeholders. These matrices identified opportunities and potential areas for improvement in future VAD digital channel design, with an emphasis on interactivity coupled with intelligence and focus along the various stages of the VAD patient journey. Innovation in digital channels has the potential to reduce burden on all users by enabling communication, self-management, and remote monitoring. Digital channels can be information enhanced for point of care, function as a decision support tools or be used to empower patient-caregiver pairs to be more sufficient with self-management, while enabling communication with their practitioner.
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23
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What Really Matters? Understanding Quality of Life Determinants Impacting Ventricular Assist Device Stakeholders. ASAIO J 2020; 66:626-636. [DOI: 10.1097/mat.0000000000001175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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24
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Left Ventricular Filling Pressures Contribute to Exercise Limitation in Patients with Continuous Flow Left Ventricular Assist Devices. ASAIO J 2020; 66:247-252. [DOI: 10.1097/mat.0000000000001073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Vandersmissen K, Jacobs S, Fresiello L, Gerits K, Roppe M, Van den Bossche K, Droogne W, Meyns B. Weight evolution after implantation of left ventricular assist device: Do we need to interfere? Int J Artif Organs 2020; 43:671-676. [PMID: 32089042 DOI: 10.1177/0391398820906554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Weight change after left ventricular assist device implantation may influence outcomes and can affect transplant candidacy. We questioned if there is a systematic weight change after left ventricular assist device implantation and examined the evolution in functional capacity. METHODS A retrospective analysis of 84 patients who received a left ventricular assist device in Universitaire Ziekenhuizen Leuven between 2008 and 2016 was performed. Patients were divided into four groups based on their baseline body mass index, and we also examined weight evolution for patients presenting with new-onset heart failure versus those suffering from chronic heart failure. Body mass index was assessed at baseline, 6, 12, 18, and 24 months. To indicate the functional capacity, we analyzed the results of routine 6-Minute Walk Test performed at 6, 12, and 18 months. RESULTS During the first 6 months after surgery, the underweight patients evolved to normal weight and the body mass index of the obese patients reduced significantly. Afterward, all patients gained weight. The weight loss of the obese was not maintained over time. The weight of patients with normal weight and overweight evolved to overweight and obesity, respectively. No body mass index changes were demonstrated for patients presenting with new-onset heart failure, and the body mass index of patients suffering from chronic HF significantly increased. There was a significant improvement in functional capacity at 6 months, but this level remained unchanged at 12 and 18 months after surgery. CONCLUSION Although the initial 6 months evolve beneficial, all patients gain weight in the second year and do not further improve their exercise capacity.
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Affiliation(s)
| | - Steven Jacobs
- Department of Cardiac Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Libera Fresiello
- Department of Cardiac Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Kathleen Gerits
- Department of Endocrinology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Marieke Roppe
- Department of Cardiac Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | | | - Walter Droogne
- Department of Cardiology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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26
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Trombara F, Apostolo A, Vignati C, Naliato M, Ceriani R, Agostoni P. Effects of left ventricular assist device on cardiopulmonary exercise performance. Eur J Heart Fail 2020; 22:381-382. [DOI: 10.1002/ejhf.1680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Filippo Trombara
- Centro Cardiologico Monzino, University of Milan, IRCCS Milan Italy
| | - Anna Apostolo
- Centro Cardiologico Monzino, University of Milan, IRCCS Milan Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, University of Milan, IRCCS Milan Italy
- Department of Clinical Sciences and Community Health, Cardiovascular SectionUniversity of Milano Milan Italy
| | - Moreno Naliato
- Centro Cardiologico Monzino, University of Milan, IRCCS Milan Italy
| | - Roberto Ceriani
- Centro Cardiologico Monzino, University of Milan, IRCCS Milan Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, University of Milan, IRCCS Milan Italy
- Department of Clinical Sciences and Community Health, Cardiovascular SectionUniversity of Milano Milan Italy
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27
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Moreno-Suarez I, Liew S, Dembo LG, Larbalestier R, Maiorana A. Physical Activity Is Higher in Patients with Left Ventricular Assist Device Compared with Chronic Heart Failure. Med Sci Sports Exerc 2020; 52:1-7. [PMID: 31834251 DOI: 10.1249/mss.0000000000002104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Left ventricular assist devices (LVAD) are associated with an increased aerobic capacity in patients with chronic heart failure (CHF). However, studies evaluating the impact of LVAD implantation on physical activity (PA) are lacking. The aim of this study was to compare daily PA levels in participants with LVAD with well-matched CHF participants. METHODS Sixteen participants with an LVAD (age, 59.1 ± 10.8 yr) were case-matched to 16 participants with advanced CHF (age, 58.3 ± 8.7 yr), who were listed or being considered for cardiac transplantation. Participants underwent a cardiopulmonary exercise test to determine peak oxygen consumption (V˙O2 peak). Physical activity was monitored continuously for seven consecutive days with an Actiheart monitor. RESULTS V˙O2 peak in the CHF group (12.3 ± 3.5 mL·kg·min) was not significantly different to the LVAD group before LVAD implantation (10.4 ± 2.1 mL·kg·min), but was lower than in the LVAD group after implantation (15.8 ± 4.3 mL·kg·min; P < 0.05). Physical activity was higher in the LVAD (19.7 ± 6.4 kJ·kg·d) compared with the CHF group (11.6 ± 6.9 kJ·kg·d; P = 0.001). The LVAD participants spent more time performing moderate-intensity PA than their CHF counterparts (median, 26 min·d; interquartile range, 24-40 min·d vs median, 12 min·d; interquartile range, 9-16 min·d; P < 0.001). Physical activity was correlated with V˙O2 peak (r = 0.582; P = 0.001) across participants in the CHF and LVAD groups. CONCLUSIONS Higher levels of PA were observed in participants with LVAD compared with patients with advanced CHF. This may be due to a higher V˙O2 peak, resulting in an improved capacity to perform activities of daily living with less symptoms.
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Affiliation(s)
| | - Sylvia Liew
- School of Physiotherapy and Exercise Science, Curtin University, Perth, AUSTRALIA
| | - Lawrence G Dembo
- Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Murdoch, AUSTRALIA
| | - Robert Larbalestier
- Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Murdoch, AUSTRALIA
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28
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Seo YG, Park WH, Oh S, Sung J, Jeon ES, Choi JO, Oh JK, Kim YH, Kim HY, Jang MJ, Choi NG, Cho YH. Clinical outcomes of inpatient cardiac rehabilitation for patients with treated left ventricular assist device in Korea: 1-year follow-up. J Exerc Rehabil 2019; 15:481-487. [PMID: 31316945 PMCID: PMC6614778 DOI: 10.12965/jer.1938124.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/07/2019] [Indexed: 11/22/2022] Open
Abstract
In Korea, the first patient with a left ventricular assist device (LVAD) for destination therapy had successful implantation of a continuous-flow model in 2012. We investigated the safety and efficacy of exercise therapy with LVAD implantation 15 Korean patients. We retrospectively reviewed 15 patients (mean age, 67.4±11.6 years; 10 males, 5 female, left ventricular ejection fraction 23.6%±7.1%), including 4 with implanted continuous-flow and 11 an axial-flow LVAD. The New York Heart Association functional classification, ejection fraction, and quality of life were obtained. Survival rate, adverse events, admission rates, and enrollment rates in cardiac rehabilitation were investigated. Survival at 6 and 12 months was 100% and 89%, respectively. The New York Heart Association functional classification improved from 3.4±0.5 to 2.3±0.05 at 12 months postoperatively (P<0.0001). The ejection fraction significantly increased from 23.6%±7.2% on the preoperative day to 35.4%±14.2% at 1 year (P<0.0018). The quality of life was also improved at 1 year (P<0.0001). The most common adverse events were bleeding (56%) and dyspnea (44%). The number of admissions was 3.2 per patient-year. LVAD therapy is a safe and effective treatment option with exercise intervention for Korean patients waiting for heart transplantation or those who were ineligible for heart transplantation. A larger study with longer follow-up is needed to determine details clinical outcomes after LVAD.
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Affiliation(s)
- Yong Gon Seo
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul, Korea
| | - Won Hah Park
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul, Korea
| | - SuKi Oh
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Jin Oh Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Jae K Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Yun Hee Kim
- Cardiac Rehabilitation and Prevention Center, Samsung Medical Center, Seoul, Korea
| | - Ho Young Kim
- Cardiac Rehabilitation and Prevention Center, Samsung Medical Center, Seoul, Korea
| | - Mi Ja Jang
- Department of Nursing, Cardiac Rehabilitation and Prevention Center, Samsung Medical Center, Seoul, Korea
| | - Nam Gyung Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea
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29
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Harmon DM, Tecson KM, Jamil AK, Felius J, Gonzalez-Stawinski GV, Joseph SM, Hall SA. Outcomes of orthotopic heart transplantation and left ventricular assist device in patients aged 65 years or more with end-stage heart failure. Proc (Bayl Univ Med Cent) 2019; 32:177-180. [PMID: 31191122 DOI: 10.1080/08998280.2019.1576095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 12/31/2022] Open
Abstract
Age has traditionally been a limiting factor for advanced heart failure (HF) therapies. Orthotopic heart transplantation (OHT) age guidelines have become less restrictive, and left ventricular assist devices (LVADs) are increasingly utilized as destination therapy for patients ≥65 years. Although indications differ, we assessed outcomes for both modalities in this older population. We reviewed charts of consecutive advanced HF therapy recipients aged ≥65 years at our center from 2012 to 2016. Of 118 patients evaluated, 46 (39%) received an LVAD and 72 (61%) received OHT. Gender, body mass index, and rate of prior sternotomy were similar between groups; OHT recipients were younger, less likely to have diabetes mellitus, and more likely to have HF due to ischemic etiology. Forty-six percent of patients receiving LVADs were urgent need (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile 1-2), compared to 29% of patients receiving OHT (United Network for Organ Sharing 1A criteria; P = 0.068). OHT recipients had shorter lengths of stay and better 1-year survival compared to LVAD recipients. Although many centers do not offer advanced HF therapy to patients aged ≥65 years, our results indicate that age alone should not be prohibitive for advanced HF therapy, particularly OHT.
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Affiliation(s)
- David M Harmon
- Department of Internal Medicine, Mayo ClinicRochesterMinnesota
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research InstituteDallasTexas
| | - Aayla K Jamil
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas
| | - Gonzalo V Gonzalez-Stawinski
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas.,Center for Advanced Heart and Lung Disease, Baylor University Medical CenterDallasTexas.,Department of Cardiac and Thoracic Surgery, Baylor University Medical CenterDallasTexas
| | - Susan M Joseph
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas.,Center for Advanced Heart and Lung Disease, Baylor University Medical CenterDallasTexas
| | - Shelley A Hall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas.,Center for Advanced Heart and Lung Disease, Baylor University Medical CenterDallasTexas
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30
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Boes S, Thamsen B, Haas M, Daners MS, Meboldt M, Granegger M. Hydraulic Characterization of Implantable Rotary Blood Pumps. IEEE Trans Biomed Eng 2019; 66:1618-1627. [DOI: 10.1109/tbme.2018.2876840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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31
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Correlates and Outcomes of Low Physical Activity Posttransplant: A Systematic Review and Meta-Analysis. Transplantation 2019; 103:679-688. [DOI: 10.1097/tp.0000000000002543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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32
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Tsuji M, Amiya E, Hatano M, Nitta D, Maki H, Bujo C, Saito A, Hosoya Y, Minatsuki S, Hara T, Nemoto M, Kagami Y, Endo M, Kimura M, Kinoshita O, Nawata K, Morita H, Ono M, Komuro I. Abdominal skeletal muscle mass as a predictor of mortality in Japanese patients undergoing left ventricular assist device implantation. ESC Heart Fail 2019; 6:526-535. [PMID: 30929311 PMCID: PMC6487708 DOI: 10.1002/ehf2.12429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/15/2019] [Indexed: 12/25/2022] Open
Abstract
Aims We assessed preoperative muscle wasting in patients undergoing left ventricular assist device (LVAD) implantations using abdominal skeletal muscle images on computed tomography (CT) and explored the associations between the preoperative muscle wasting and clinical outcomes after LVAD implantation. Methods and results We retrospectively examined the records of 111 patients who underwent continuous‐flow LVAD implantations as bridge‐to‐transplant therapy from January 2010 to December 2016 at our institution. After 33 patients were excluded, the study cohort consisted of 78 individuals. CT images used to calculate the skeletal muscle index (SMI) at the third lumbar vertebra level were obtained before the LVAD implantation procedures. Patients were classified as having muscle wasting if their SMI fell into the lowest gender‐based tertile. The median SMI for the study patients was 37.6 cm2/m2. The SMI cut‐off values for the lowest tertiles were 36.7 cm2/m2 for men and 28.2 cm2/m2 for women, resulting in 26 patients (33.3%) with muscle wasting in this study. During the mean follow‐up of 738 ± 379 days, there were 10 deaths (12.8% mortality). Seven of the 26 patients with muscle wasting (26.9%) died, and 3 of the 52 patients without muscle wasting (5.8%) died. The times to all‐cause mortality were significantly different between patients with and without muscle wasting (P = 0.0094). Muscle wasting was found to be associated with mortality in univariate and multivariate Cox analyses (hazard ratio: 4.32; 95% CI: 1.19–20.2). Conclusions Preoperative muscle wasting was associated with a higher mortality in patients with LVAD. Assessment of the abdominal skeletal muscle area on CT prior to LVAD implantation can help predict mortality.
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Affiliation(s)
- Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daisuke Nitta
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chie Bujo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yumiko Hosoya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Hara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mariko Nemoto
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukie Kagami
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Miyoko Endo
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsutoshi Kimura
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kan Nawata
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
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Quadriceps Muscle Strength and Body Mass Index Are Associated With Estimates of Physical Activity Postheart Transplantation. Transplantation 2018; 103:1253-1259. [PMID: 30335695 DOI: 10.1097/tp.0000000000002488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although exercise capacity improves postheart transplantation (HTx), it remains unclear if the level of physical activity (PA) shows similar improvement. The purpose of this study was to (1) describe PA levels and (2) identify factors which may be associated with levels of PA post-HTx. METHODS A prospective observational cross-sectional study was conducted at a single center HTx outpatient clinic. Medically stable adult recipients 6 months or longer post-HTx were recruited. Physical activity level (PAL) and average daily time spent at least moderately active (≥3 metabolic equivalents) were estimated using a multisensor device. Factors investigated were demographic (age, sex, body mass index [BMI], time post-HTx, and reason for HTx), corticosteroid use, exercise capacity (6-min walk distance), and quadriceps muscle strength corrected for body weight (QS%). RESULTS The mean post-HTx time of the 75 participants was 9.2 ± 7.0 years (0.5-26 y). Twenty-seven (36%) participants were classified as extremely inactive (PAL, <1.40), 26 (34.6%) sedentary (1.40 ≤ PAL ≤ 1.69), and 22 (29.3%) active (PAL, ≥1.70). Multivariable analysis showed greater QS% (β = 0.004 (0.002-0.006) P = 0.001) to be independently associated with increased PAL. For increased time, 3 or more metabolic equivalents both greater QS% (β = 0.0164 [0.003-0.029]; P = 0.014) and lower BMI (β = -0.0626 [-0.115 to -0.0099]; P = 0.021) were independently associated. CONCLUSIONS The degree of observed sedentary behavior post-HTx is surprising, with the majority of participants not reaching levels of PA recommended for health benefits. QS% and BMI were the only factors found to be independently associated with estimates of PA. Further quality trials are required to demonstrate the long-term benefits of regular PA and investigate ways of increasing adherence to PA post-HTx.
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Tackmann E, Dettmer S. Health-related quality of life in adult heart-transplant recipients—a systematic review. Herz 2018; 45:475-482. [DOI: 10.1007/s00059-018-4745-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/15/2018] [Accepted: 08/09/2018] [Indexed: 02/02/2023]
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Magnetta DA, Kang J, Wearden PD, Smith KJ, Feingold B. Cost-Effectiveness of Ventricular Assist Device Destination Therapy for Advanced Heart Failure in Duchenne Muscular Dystrophy. Pediatr Cardiol 2018; 39:1242-1248. [PMID: 29774392 DOI: 10.1007/s00246-018-1889-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/02/2018] [Indexed: 11/28/2022]
Abstract
Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF. Model input parameters were derived from the literature. We used sensitivity analyses to explore uncertainty around model assumptions. DT-VAD had higher costs ($435,602 vs. $125,696), survival (3.13 vs. 0.60 years), and quality-adjusted survival (1.99 vs. 0.26 years) than medical management. The incremental cost-effectiveness ratio (ICER) for DT-VAD was $179,086 per quality-adjusted life year (QALY). In sensitivity analyses that were widely varied to account for uncertainty in model assumptions, the DT-VAD strategy generally remained more costly and effective than medical management. Only when VAD implantation costs were <$113,142 did the DT-VAD strategy fall below the $100,000/QALY willingness-to-pay threshold commonly considered to be "cost-effective." In this exploratory analysis, DT-VAD for patients with DMD and advanced HF exceeded societal expectations for cost-effectiveness but had an ICER similar to the accepted practice of DT-VAD in adult HF patients. While more experience and research in this population is needed, our analysis suggests that DT-VAD for advanced HF in DMD should not be dismissed solely based on cost.
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Affiliation(s)
- Defne A Magnetta
- Pediatrics, Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion Floor 5, Pittsburgh, PA, 15224, USA.
| | - JaHyun Kang
- College of Nursing, Seoul National University, Seoul, South Korea.,Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Peter D Wearden
- Cardiothoracic Surgery, Nemours Children's Hospital, Orlando, FL, USA
| | - Kenneth J Smith
- Section of Decision Sciences, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian Feingold
- Pediatrics, Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion Floor 5, Pittsburgh, PA, 15224, USA.,Clinical and Translational Research, University of Pittsburgh, Pittsburgh, PA, USA
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Reiss N, Schmidt T, Boeckelmann M, Schulte-Eistrup S, Hoffmann JD, Feldmann C, Schmitto JD. Telemonitoring of left-ventricular assist device patients-current status and future challenges. J Thorac Dis 2018; 10:S1794-S1801. [PMID: 30034855 DOI: 10.21037/jtd.2018.01.158] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
E-health, especially telemedicine, has undergone a remarkably dynamic development over the past few years. Most experience is currently in the field of telemedical care for heart failure (HF) patients. However, HF patients with an implanted left-ventricular assist device (LVAD) have been more or less excluded from consistent telemonitoring until now. And yet, continual monitoring would be very significant for this patient group because of the complexity of its aftercare, requiring steady control of various parameters (device-related parameters, vital parameters, coagulation parameters, etc.). With timely action, severe and costly complications like pump thromboses and driveline infections could be detected early on or even avoided completely. This paper describes the potential of telemonitoring in LVAD patients, as well as its first clinical implementation according to the available literature. It also describes the requirements for a complete telemonitoring of LVAD patients, facilitating the advancement of this form of continual monitoring to a clinical standard which would increase the quality of aftercare for this very special patient collective enormously.
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Affiliation(s)
- Nils Reiss
- Department for Clinical Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Thomas Schmidt
- Department for Clinical Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Michael Boeckelmann
- Department for Clinical Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | | | - Jan-Dirk Hoffmann
- Department for Clinical Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Christina Feldmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Casida JM, Davis JE, Pagani FD, Aikens JE, Williams C, Yang JJ. Sleep and self-care correlates before and after implantation of a left-ventricular assist device (LVAD). J Artif Organs 2018; 21:278-284. [DOI: 10.1007/s10047-018-1043-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/06/2018] [Indexed: 01/02/2023]
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Quality of life with an LVAD: A misunderstood concept. Heart Lung 2018; 47:177-183. [PMID: 29551363 DOI: 10.1016/j.hrtlng.2018.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/08/2018] [Indexed: 11/21/2022]
Abstract
The present study aims to synthesize current evidence on the impact of LVAD implantation on quality of life. Current evidence was systematically reviewed to obtain relevant quantitative and qualitative articles published after 2007. Sandelowski's recommended steps for meta-summary were used to analyze the 19 studies that met the inclusion criteria. LVADs can improve HF symptoms and some aspects of QoL. Emotional and physical adaptation involves many changes and learning to manage the device takes time. Functional limitations still exist and patients still lack independence. LVAD-related complications significantly impact QoL. Psychological distress remains high after implantation. LVADs significantly impact the caregiver as well and their perspective is not well heard in the existing evidence. It is important for providers to have ongoing, in-depth discussions with patients and their caregivers regarding treatment options, goals of care, anticipated end-of-life trajectories with an LVAD, possible LVAD-complications, and the caregiver burden associated with an LVAD.
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Schmidt T, Bjarnason-Wehrens B, Mommertz S, Hannig M, Schulte-Eistrup S, Willemsen D, Reiss N. Changes in Total Cardiac Output and Oxygen Extraction During Exercise in Patients Supported With an HVAD Left Ventricular Assist Device. Artif Organs 2018; 42:686-694. [DOI: 10.1111/aor.13102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/03/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Thomas Schmidt
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde; Cologne Germany
- Department for Preventive and Rehabilitative Sport and Exercise Medicine; Institute for Cardiology and Sports Medicine, German Sports University Cologne; Cologne Germany
| | - Birna Bjarnason-Wehrens
- Department for Preventive and Rehabilitative Sport and Exercise Medicine; Institute for Cardiology and Sports Medicine, German Sports University Cologne; Cologne Germany
| | | | - Meike Hannig
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde; Cologne Germany
| | | | - Detlev Willemsen
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde; Cologne Germany
| | - Nils Reiss
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde; Cologne Germany
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40
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Selig S, Foulkes S, Haykowsky M. Improvements in exercise capacity following cardiac transplantation in a patient born with double inlet left ventricle. BMJ Case Rep 2018; 2018:bcr-2017-223169. [PMID: 29437740 PMCID: PMC5836704 DOI: 10.1136/bcr-2017-223169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 32-year-old man born with double inlet left ventricle (DILV) and other significant cardiac abnormalities underwent surgical palliation at 1 day, 2 years and 20 years, before receiving a donor heart at 29 years. To our knowledge, there are no case reports or cohort studies of the effect of exercise training on exercise capacity and peak oxygen uptake (VO2peak) following heart transplantation (HTx) for individuals born with DILV. The patient accessed our clinical exercise physiology service for assessment, advice and support for exercise training over a 7-year period spanning pre-HTx and post-HTx. An individualised exercise plan, together with careful assessment and monitoring, and the patient’s own motivation have contributed to him achieving an outstanding post-HTx doubling of VO2peak and exercise capacity.
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Affiliation(s)
- Steve Selig
- School of Exercise & Nutrition Sciences, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Steve Foulkes
- School of Exercise & Nutrition Sciences, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Mark Haykowsky
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas, USA
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41
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Exercise Performance During the First Two Years After Left Ventricular Assist Device Implantation. ASAIO J 2018; 63:408-413. [PMID: 28657929 DOI: 10.1097/mat.0000000000000569] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Exercise performance of patients with left ventricular assist devices (LVADs) improves after postimplant cardiac rehabilitation (CR). Few studies assess the effectiveness of a CR and its long-term effect of exercise performance. For this purpose, we retrospectively analyzed data from LVAD patients, who underwent a stationary CR twice after pump implantation. Data from exercise training and cardiopulmonary exercise tests (CPETs) were analyzed. Fifteen patients (age: 57 ± 10 years, male 87%) were admitted to the rehabilitation clinic twice 39 ± 18 and 547 ± 197 days after LVAD implantation. An improvement from the beginning to the end of the second CR was observed in bicycle ergometer training (14.0 ± 8.8 vs. 35.7 ± 14.7 W; p < 0.001), in muscular strength (e.g., leg press: 41 ± 10 vs. 53 ± 14 kg; p < 0.001), and in 6 minute walk distance (421 ± 126 m vs. 480 ± 133 m; p = 0.040). Between the first and the second CR, improvement in all the training modules was observed as well as an increase in CPETs peak workload (56 ± 24 vs. 83 ± 26 W; p < 0.001) but not in peak oxygen consumption (12.3 ± 3.2 vs. 12.2 ± 4.0 ml/min/kg; p = 0.906). Thus, over long implant periods, patients showed improvement of their exercise performance in the submaximal load range, but no change in the aerobic capacity was observed.
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42
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Theochari CA, Michalopoulos G, Oikonomou EK, Giannopoulos S, Doulamis IP, Villela MA, Kokkinidis DG. Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis. Ann Cardiothorac Surg 2018; 7:3-11. [PMID: 29492379 DOI: 10.21037/acs.2017.09.18] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The optimal treatment for advanced heart failure (HF) patients with regards to mortality remains unknown. Heart transplantation (HTx) and left ventricular assist devices (LVAD) used either as a bridge to transplant (BTT) or destination therapy (DT) have been compared in a number of studies, without definite conclusions with regards to mortality benefit. We sought to systematically review the pertinent literature and perform a meta-analysis of all the available studies presenting head-to-head comparisons between HTx and LVAD BTT or LVAD DT for late (>6 months) all-cause mortality. Methods We performed a systematic search of Medline and Cochrane Central databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a meta-analysis of late mortality comparing HTx vs. BTT LVAD and HTx vs. DT LVAD using a random effects model. Results Eight studies were included in our meta-analysis, reporting data on 7,957 patients in total. Although the available studies are of high quality [8 stars in Newcastle-Ottawa Scale (NOS) on average], there is paucity of mortality data. Specifically, seven studies compared HTx with BTT and five studies compared HTx with DT for 1-year mortality. Our pooled estimates showed that there was no difference in late mortality among these strategies. Conclusions Our meta-analysis highlights the small number and the heterogeneity of available studies referring to the optimal invasive management of advanced HF, and shows that there are no differences between HTx and LVAD for these patients with regards to late mortality.
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Affiliation(s)
- Christina A Theochari
- School of Medicine, University of Athens, Athens, Greece.,Division of Internal Medicine, Society of Junior Doctors, Marousi, Greece
| | - George Michalopoulos
- School of Medicine, University of Athens, Athens, Greece.,Division of Internal Medicine, Society of Junior Doctors, Marousi, Greece
| | | | | | - Ilias P Doulamis
- School of Medicine, University of Athens, Athens, Greece.,Division of Internal Medicine, Society of Junior Doctors, Marousi, Greece
| | - M Alvarez Villela
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Damianos G Kokkinidis
- Division of Internal Medicine, Society of Junior Doctors, Marousi, Greece.,Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Bowles CT, Hards R, Wrightson N, Lincoln P, Kore S, Marley L, Dalzell JR, Raj B, Baker TA, Goodwin D, Carroll P, Pateman J, Black JJM, Kattenhorn P, Faulkner M, Parameshwar J, Butcher C, Mason M, Rosenberg A, McGovern I, Weymann A, Gwinnutt C, Banner NR, Schueler S, Simon AR, Pitcher DW. Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices. Emerg Med J 2017; 34:842-850. [PMID: 29127102 PMCID: PMC5750371 DOI: 10.1136/emermed-2016-206172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/27/2017] [Accepted: 09/02/2017] [Indexed: 11/04/2022]
Abstract
Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients.
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Affiliation(s)
- Christopher T Bowles
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rachel Hards
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Neil Wrightson
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Paul Lincoln
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Shishir Kore
- Department of Cardiothoracic Transplantation, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Laura Marley
- Department of Cardiothoracic Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jonathan R Dalzell
- Scottish Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Binu Raj
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Tracey A Baker
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Diane Goodwin
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Petra Carroll
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jane Pateman
- Anaesthetic Department, Royal Sussex County Hospital, Brighton, UK
| | - John J M Black
- Clinical Directorate, South Central Ambulance Service Foundation Trust, Oxfordshire, UK
| | - Paul Kattenhorn
- East of England Ambulance Service Headquarters, Whiting Way, Melbourn, Cambs., SG8 6EN., East of England Ambulance Service Headquarters, Melbourn, Cambs, UK
| | - Mark Faulkner
- London Ambulance Service, Medical Directorate Office, London, UK
| | - Jayan Parameshwar
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Charles Butcher
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mark Mason
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alexander Rosenberg
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ian McGovern
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alexander Weymann
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Nicholas R Banner
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stephan Schueler
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Andre R Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Abstract
Solid organ transplantation is the criterion standard treatment for many with end-organ failure and can offer a new independence from the burden of disease. However solid organ transplant recipients (SOTRs) remain at high risk of cardiovascular (CV) disease, and poor quality of life and physical functioning. Increasing physical activity and exercise can improve the health of the general population; however, the effects on those with a transplant remain unclear. Intensive exercise and sporting activity has the potential to be beneficial, although there remain concerns particularly around the effects on immune function and the CV system. This review summarizes what is known about the effects of exercise on determinants of health in SOTRs and then collates the available literature investigating the consequences of intensive exercise and sport on the health of SOTR. There is a paucity of high-quality research, with most evidence being case studies or anecdotal; this is understandable given the relatively few numbers of SOTRs who are performing sport and exercise at a high level. However, if suitable evidence-based guidelines are to be formed and SOTRs are to be given reassurances that their activity levels are not detrimental to their transplanted organ and overall health, then more high-quality studies are required.
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Readmissions after continuous flow left ventricular assist device implantation. J Artif Organs 2017; 20:311-317. [DOI: 10.1007/s10047-017-0975-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
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Jakovljevic DG, Yacoub MH, Schueler S, MacGowan GA, Velicki L, Seferovic PM, Hothi S, Tzeng BH, Brodie DA, Birks E, Tan LB. Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure. J Am Coll Cardiol 2017; 69:1924-1933. [PMID: 28408022 PMCID: PMC5388890 DOI: 10.1016/j.jacc.2017.02.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy, or in some patients, as a bridge to recovery. OBJECTIVES This study evaluated whether patients undergoing an LVAD bridge-to-recovery protocol can achieve cardiac and physical functional capacities equivalent to those of healthy controls. METHODS Fifty-eight male patients-18 implanted with a continuous-flow LVAD, 16 patients with LVAD explanted (recovered patients), and 24 heart transplant candidates (HTx)-and 97 healthy controls performed a maximal graded cardiopulmonary exercise test with continuous measurements of respiratory gas exchange and noninvasive (rebreathing) hemodynamic data. Cardiac function was represented by peak exercise cardiac power output (mean arterial blood pressure × cardiac output) and functional capacity by peak exercise O2 consumption. RESULTS All patients demonstrated a significant exertional effort as demonstrated with the mean peak exercise respiratory exchange ratio >1.10. Peak exercise cardiac power output was significantly higher in healthy controls and explanted LVAD patients compared with other patients (healthy 5.35 ± 0.95 W; explanted 3.45 ± 0.72 W; LVAD implanted 2.37 ± 0.68 W; and HTx 1.31 ± 0.31 W; p < 0.05), as was peak O2 consumption (healthy 36.4 ± 10.3 ml/kg/min; explanted 29.8 ± 5.9 ml/kg/min; implanted 20.5 ± 4.3 ml/kg/min; and HTx 12.0 ± 2.2 ml/kg/min; p < 0.05). In the LVAD explanted group, 38% of the patients achieved peak cardiac power output and 69% achieved peak O2 consumption within the ranges of healthy controls. CONCLUSIONS The authors have shown that a substantial number of patients who recovered sufficiently to allow explantation of their LVAD can even achieve cardiac and physical functional capacities nearly equivalent to those of healthy controls.
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Affiliation(s)
- Djordje G Jakovljevic
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Clinical Research Facility, Newcastle Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
| | | | - Stephan Schueler
- Cardiothoracic Centre, Freeman Hospital, and Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Guy A MacGowan
- Cardiothoracic Centre, Freeman Hospital, and Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, and Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Novi Sad, Serbia
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School, Belgrade, Serbia
| | - Sandeep Hothi
- Physiological Laboratory and Murray Edwards College, University of Cambridge, Cambridge, and Department of Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - Bing-Hsiean Tzeng
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital and Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - David A Brodie
- Cardiovascular Research Centre, Buckinghamshire New University, Bucks, London, United Kingdom
| | - Emma Birks
- Department of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Lip-Bun Tan
- Leeds General Infirmary, Cardiology and Institute of Medical Sciences, Leeds University, Leeds, United Kingdom
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Abstract
PURPOSE OF REVIEW The majority of patients currently implanted with left ventricular assist devices have the expectation of support for more than 2 years. As a result, survival alone is no longer a sufficient distinctive for this technology, and there have been many studies within the last few years examining functional capacity and exercise outcomes. RECENT FINDINGS Despite strong evidence for functional class improvements and increases in simple measures of walking distance, there remains incomplete normalization of exercise capacity, even in the presence of markedly improved resting hemodynamics. Reasons for this remain unclear. Despite current pumps being run at a fixed speed, it is widely recognized that pump outputs significantly increase with exercise. The mechanism of this increase involves the interaction between preload, afterload, and the intrinsic pump function curves. The role of the residual heart function is also important in determining total cardiac output, as well as whether the aortic valve opens with exercise. Interactions with the vasculature, with skeletal muscle blood flow and the state of the autonomic nervous system are also likely to be important contributors to exercise performance. SUMMARY Further studies examining optimization of pump function with active pump speed modulation and options for optimization of the overall patient condition are likely to be needed to allow left ventricular assist devices to be used with the hope of full functional physiological recovery.
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Cardiac Rehabilitation After Complex Procedures. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kalathiya RJ, Houston BA, Chaisson JM, Grimm JC, Stevens GR, Sciortino CM, Shah AS, Whitman GJR, Russell SD, Tedford RJ. Cardiac Index Declines During Long-Term Left Ventricular Device Support. Artif Organs 2016; 40:1105-1112. [DOI: 10.1111/aor.12733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Joshua C. Grimm
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore MD USA
| | | | | | - Ashish S. Shah
- Division of Cardiac Surgery; The Johns Hopkins Hospital; Baltimore MD USA
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Emin A, Rogers CA, Banner NR. Quality of life of advanced chronic heart failure: medical care, mechanical circulatory support and transplantation. Eur J Cardiothorac Surg 2016; 50:269-73. [PMID: 27107045 DOI: 10.1093/ejcts/ezw054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 01/25/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Advanced chronic heart failure (ACHF) is progressive with poor prognosis and quality of life (QoL). Heart transplantation (HTx) is an effective treatment for ACHF, but is limited by scarcity of donor hearts. Left ventricular assist device (LVAD) support is a useful bridging therapy, and short- and medium-term outcomes have improved. We investigated QoL in patients assessed for HTx, awaiting HTx and after HTx. METHODS We carried out a cross-sectional survey across four groups: Group 1-patients assessed for HTx, Group 2-patients listed for HTx on medical therapy, Group 3-patients supported with LVAD and Group 4-patients after HTx. Two questionnaires, the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQol dimensions (EQ-5D), were administered in all adult HTx centres in the UK. Scores calculated for the KCCQ and EQ-5D were compared. RESULTS Three hundred and eighty-six patients completed questionnaires: 194 in Group 1, 28 in Group 2, 82 in Group 3 and 82 in Group 4. Patients after HTx reported the best QoL [KCCQ overall summary score: mean 73.0 (SD 27.2)]; patients with LVAD reported better QoL than those being assessed for HTx and those listed for HTx on medical therapy [overall summary score; LVAD: 52.6 (22.0), Listed on medical therapy: 33.3 (21.1), ASSESSMENT: 35.5 (21.5)]. Similarly, EQ-5D scores were highest in patients after HTx [HTx: mean 0.74 (0.27); LVAD: 0.58 (0.26), Listed on medical therapy: 0.44 (0.27), ASSESSMENT: 0.50 (SD 0.30)]. CONCLUSIONS Patients supported with LVAD had a significantly better QoL than those awaiting HTx without LVAD support, although HTx patients reported the best QoL.
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Affiliation(s)
- Akan Emin
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Chris A Rogers
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Nicholas R Banner
- Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
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