Physiotherapy and Rehabilitation Management in Adult LVAD Patients

Increasing numbers of patients require implantation of permanent ventricular assist devices (VADs) for treatment of refractory end-stage heart failure [1, 2], as confirmed by surveys conducted in several European hospitals [3, 4]. VADs have been initially employed either as a bridge to recovery or bridge to transplantation [5]. It has been reported that 78% of VAD implants (between 2002 and 2004) have been used as bridge to transplantation, 11.9% as destination therapy, and 5.3% as bridge to recovery [6]: rehabilitation management, if we consider these data, would be centered on maintaining motor abilities in order to prepare patient for a future transplantation when VADs are used as bridge treatment. Such a trend is nowadays differing since, due to the donor crisis, VADs are increasingly used as destination therapy. Although this practice is widely experienced in end-stage heart failure populations, mortality remains high: appropriateness of enrollment criteria is determinant in order to avoid inappropriate patient selection. In this regard, it has been found that patient’s frailty reduce the left ventricular assist devices (LVADs) outcomes; mortality at 1 year after implantation is higher in frail patients when compared with not frails [7]. Earlier reviews examined indications for LVAD use, LVAD suitability, cost-effectiveness, and the utility of the devices when used to treat refractory end-stage heart disease [8–16]. VAD implantation is indicated in order to augment or replace left ventricle (LVAD), right ventricle (RVAD), or both ventricle (BiVAD) function [6]. Postoperative complications of physiotherapic interest are mainly represented by infections, bleeding, thromboembolic events, device malfunction, and depression [17]. Indeed, postoperative rehabilitation in VAD recipients does not substantially differ from common cardiac surgery patients, as the main goals are related to the treatment/prevention of postoperative pulmonary complications, in the early phase. One of the major differences between common surgery patients and LVAD recipients consists in the complexity of the preoperative general conditions, being LVAD patients more prone to physical deconditioning often determined by forced bed rest and physical inactivity. Another substantial difference concerns the safety issues related to the device management, either by patients or by those providing care, including caregivers.