EARLY PROGRESSIVE MOBILIZATION OF PATIENTS WITH LEFT-VENTRICULAR ASSIST DEVICES IS SAFE AND OPTIMIZES RECOVERY BEFORE HEART-TRANSPLANTATION

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.