Tm. Morrone et al., EARLY PROGRESSIVE MOBILIZATION OF PATIENTS WITH LEFT-VENTRICULAR ASSIST DEVICES IS SAFE AND OPTIMIZES RECOVERY BEFORE HEART-TRANSPLANTATION, The Journal of heart and lung transplantation, 15(4), 1996, pp. 423-429
Background: As early perioperative survival with left ventricular assi
st device support improves, additional emphasis must be placed on pati
ent rehabilitation. Especially as mean left ventricular assist device
support times exceed 100 days, it is essential for health professional
s to mobilize patients to prevent the incidence of the deleterious eff
ects of bedrest. The timing of optimal functional performance and the
safety of rehabilitation has not been described.Methods: We retrospect
ively studied patients surviving left ventricular assist device implan
tation (34 of 41 patients; 27 men, 7 women; age 51 +/- 11 years). Phys
ical therapy consisted of progressive mobilization leading to treadmil
l exercise or cycling. All patients exercised in the ''pump on full''
mode with flows greater than or equal to 3.0 L/min. Results: Twenty of
thirty-four patients initiated ambulation at 7 to 10 days with indepe
ndent ambulation by 14 days in 55% of the group. Treadmill exercise wa
s tolerated by 82% of the patients, begun at postoperative day 21 by e
ighteen patients. The greatest improvement in exercise performance was
seen by 6 to 8 weeks (20 to 30 minutes at 3.17 +/- 0.79 metabolic equ
ivalents). Maximal functional capacity achieved was influenced by medi
cal complications. A total of 1878 treatment sessions lasting 1390 hou
rs was performed. Only four minor incidents occurred representing 2.9
incidents/1000 patient hours; all involved a transient decrease in pum
p flow. None of these events resulted in an increase in morbidity or m
ortality. Conclusions: Progressive mobilization in patients with left
ventricular assist device is safe, Patients return to independence in
activities of daily living and tolerate prolonged workloads of up to 5
metabolic equivalents. There is rapid improvement in functional capac
ity until 6 weeks after operation. Delay in transplantation until this
time may optimize postoperative recovery.