Background Implantation of modern durable left ventricular assist device (LVAD) in advanced heart failure (HF) patients is associated with increased survival and improved quality of life. Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to exercise capacity in HF patients but data on effect of EBCR in advanced HF patients with LVAD are limited. Objectives To evaluate the effect of EBCR program on the functional capacity of advanced heart failure patients with LVAD Methods Out of the current 64 LVAD recipients in Hong Kong, 43 patients who have had LVAD implanted and survived 1 year were screened. The EBCRP consisted of cardiorespiratory and strength training exercise once a week for a total of 24 sessions (6 months). The functional rehabilitation outcome was evaluated by 6 minute walk test (6MWT) at baseline, before LVAD implantation, pre-EBCR and by end of EBCP ( 6 months). The muscle strength was evaluated by an isokinetic knee extension strength test defined by 10 repetitive maximum (RM) torque of quadriceps strength before starting EBCR and at 6 months upon termination of EBCR. Results A total of 33 LVAD patients were recruited into our EBCR program. There were 27 (82%) men with mean age of 48.7± 13.6 years. Average duration from LVAD surgery to commencement of EBCR was 5.3 months. Baseline 6MWT could not be performed in 21 patients due to extreme poor functional class (NYHA class IV) with prolonged hospitalizations requiring inotropes and circulatory support. For the other 12 patients, there were no significant differences in 6 MWT at baseline and post LVAD before starting EBCP. Overall 6MWT significantly improved by end of EBCR (pre- EBCR mean 382.2, ±95.2m vs post -EBCR mean 440.8 ±88.2m p= 0.001). There were significant improvement in quadriceps strength by the end of EBCRP program. (pre- CRP 1.8 ± 2.5 kg vs post CRP 3.5 ± 3.5 kg p < 0.001). Conclusions LVAD patients show high level of impairment of functional capacity despite after LVAD imaplntation with improved circulatory output. EBCR program allowed greater improvement in exercise capacity evolution and peripheral physiology such as muscle strengthening.
Left ventricular assist device (LVAD) has been used for end-stage heart failure both as bridge to transplantation (BTT) and destination therapy (DT) for patients not suitable for heart transplantation. Stroke is a major cause of morbidity and mortality associated with LVAD therapy. We aimed to review the incidence and outcome of stroke during LVAD therapy in Hong Kong.Patients who had LVAD implantation from August 2010 to August 2018 for end-stage heart failure were reviewed. A total of 65 patients had LVAD implanted for end-stage heart failure (57 as BTT, 87.7%). The majority were male (n=55, 84.6%), with mean age of 49 years. Overall survival rates were 86.2% at 6 months and 79.2% at 12 months. There were 43 HeartMate IITM, 14 HeartWareTM HVADTM and 8 HeartMate 3TM implants. Twenty neurological events occurred in 18 patients with 10 cases of disabling stroke throughout the whole study period. There were 11 haemorrhagic strokes, 7 ischaemic strokes and 2 transient ischaemic attacks. Stroke and disabling stroke rates at 6 months were 20.7% and 12.1%, respectively. Disabling strokes were more common when haemorrhagic in origin (7 out of 10) and were the commonest cause of mortality in 9 out of 15 (60%) patients throughout the study period.In conclusion, stroke remains an important cause of morbidity and mortality among Hong Kong patients receiving LVAD therapy.
BackgroundLeft ventricular assist device (LVAD) has been used for end-stage heart failure both as bridge to transplantation (BTT) and destination therapy (DT) for patients not suitable for heart transplantation. We aimed to review the experience of LVAD therapy in Hong Kong.MethodPatients who had LVAD implantation from August 2010 to October 2017 for end-stage heart failure were reviewed.ResultsA total of 55 patients had LVAD implanted for end-stage heart failure (48 as BTT, 87.3%). Majority are male (n=45, 81.8%) with mean age 49 years, and mean left ventricular ejection fraction 17%. Most patients were INTERMACS 2 to 3 (n=43, 78.2%) while nine patients (16.4%) were INTERMACS 1. Overall survival rates were 84.7% at 6 months, 80.8% at 12 months, 78.3% at 2 year and 68% at 4 year. Long-term survival was not significantly different between BTT and DT groups (70.1% vs 51.4% at 4 year, p=0.099 by log-rank) while survival was significantly inferior for INTERMACS 1 patients (26.7% vs 76.2% at 4 year, p=0.016). Most common complication was driveline infection (29.1%) followed by cerebrovascular accident (23.6%), gastrointestinal bleeding (20%), ventricular arrhythmia (14.5%), right heart failure (10.9%), sepsis (9.1%) and driveline malfunction (7.3%). Pump thrombosis occurred in only 1 case (1.8%).ConclusionLVAD therapy as BTT has become the standard therapy for potential heart transplant candidates in Hong Kong and its role as DT is also emerging. Timely recognition and referral is the key to achieve the best outcome in this sick patient population.
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