Safety and efficacy of cardiac rehabilitation for patients with continuous flow left ventricular assist devices

Background Despite the increasing use of left ventricular assist devices (LVADs) in terminal heart failure, cardiac rehabilitation protocols have not yet been documented in larger LVAD patient cohorts. The aim of this study was to investigate safety and efficacy of exercise training during a rehabilitation programme after post-operative discharge of LVAD patients. Methods Rehabilitation data obtained between 2010-2012 from 41 LVAD patients (mean age 54.811.6 years; 20% female) were retrospectively analysed. The exercise protocol consisted of strength exercises for lower limbs, bicycle ergometry, walking and gymnastics. The numbers of training sessions, their duration and intensity as well as adverse events were documented. Spiroergometry was performed at least once and twice in a subgroup of 15 patients (at the beginning and end of rehabilitation). Results Rehabilitation started 48 +/- 38 days post LVAD implantation with an average duration of 32 +/- 6 days. An increase in exercise capacity was observed. Duration (19 +/- 4 vs 14 +/- 2min, p<0.001) and intensity of bicycle ergometry increased (module number 6.2 +/- 2.8 vs 2.0 +/- 1.9, p<0.001) as well as muscular strength all muscle groups trained (e.g. 33.6 +/- 15.2 vs 26.6 +/- 11.9kg at the leg press, p=0.002). Spiroergometry revealed an increase of maximal oxygen consumption (14.5 +/- 5.2 vs 11.3 +/- 4.1ml/min/kg, p=0.007) in the subgroup that underwent two examinations. In the whole population the average increase was lower (12.81 +/- 4.35ml/min/kg). One training-related adverse event (non-sustained ventricular tachycardia) was observed. Conclusion Exercise training for LVAD patient as part of a multidisciplinary rehabilitation programme is effective and safe. This warrants the broad application of exercise training after LVAD implantation.