Exercise blood pressure response during assisted circulatory support: Comparison of the total artifical heart with a left ventricular assist device during rehabilitation

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:30

Article

Kohli, Harajeshwar S.¹  Canada, Justin²  Arena, Ross²  Tang, Daniel G.³  Peberdy, Mary Ann¹  Harton, Suzanne¹  Flattery, Maureen¹  Doolin, Kelly¹  Katlaps, Gundars J.³  Hess, Michael L.¹  Kasirajan, Vigneshwar³  Shah, Keyur B.¹ 

[1] Virginia Commonwealth Univ, Div Cardiol, Richmond, VA 23298 USA

[2] Virginia Commonwealth Univ, Dept Phys Therapy, Richmond, VA 23298 USA

[3] Virginia Commonwealth Univ, Div Cardiothorac Surg, Richmond, VA 23298 USA

关键词: total artificial heart;    physical therapy;    rehabilitation;    exercise;    mechanical circulatory support;    heart failure;   

DOI  :  10.1016/j.healun.2011.07.001

来源: Elsevier

【 摘 要 】

BACKGROUND: The total artificial heart (TAH) consists of two implantable pneumatic pumps that replace the heart and operate at a fixed ejection rate and ejection pressure. We evaluated the blood pressure (BP) response to exercise and exercise performance in patients with a TAH compared to those with a with a continuous-flow left ventricular assist device (LVAD). METHODS: We conducted a single-center, retrospective study of 37 patients who received a TAH and 12 patients implanted with an LVAD. We measured the BP response during exercise, exercise duration and change in tolerated exercise workload over an 8-week period. RESULTS: In patients with a TAH, baseline BP was 120/69 +/- 13/13, exercise BP v. as 118/72 +/- 15/10 and post-exercise BP was 120/72 +/- 14/12. Mean arterial BP did not change with exercise in patients with a TAH (88 +/- 10 vs 88 +/- 11; p = 0.8), but increased in those with an LVAD (87 +/- 8 vs 95 +/- 13; p < 0.001). Although the mean arterial BP (MAP) was negatively correlated with metabolic equivalents (METs) achieved during exercise, the association was not statistically significant (beta = -0.1, p = 0.4). MAP correlated positively with METs achieved in patients with LVADs (MAP: beta = 0.26, p = 0.04). Despite the abnormal response to exercise, patients with a TAH participated in physical therapy (median: 5 days; interquartile range [IQR] 4 to 7 days) and treadmill exercise (19 days; IQR: 13 to 35 days) early after device implantation, with increased exercise intensity and duration over time. CONCLUSIONS: During circulatory support with a TAH, the BP response to exercise was blunted. However, aerobic exercise training early after device implantation was found to be safe and feasible in a supervised setting. J Heart Lung Transplant 2011;30:1207-13 (C) 2011 International Society for Heart and Lung Transplantation All rights reserved.

【 授权许可】

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