Changes in the Functional Status Measures of Heart Failure Patients With Mechanical Assist Devices

Leibner, Evan; Cysyk, Joshua; Eleuteri, K.L.; El‐Banayosy, Aly; Boehmer, John; Pae, Walter E.

doi:10.1097/mat.0b013e3182816cb7

Cited by 64 publications

(45 citation statements)

References 17 publications

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“…[16][17][18] Two small studies with paired pre-and postimplant VO 2 showed similarly small increases in VO 2 max after 3-6 months of support. 19,20 Recently, Nahumi et al 21 2.0 ± 0.7 Mixed venous oxygen saturation (%) 50.8 ± 12.8 Right ventricular stroke-work index (g/m 2 /beat) 6.9 ± 3.3 Right ventricular failure risk score, n (%) ‡ ≤3 31 (89) 4-5 2 (6) ≥5. 5 2 (6) Plus-minus values are mean ± SD.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Assist Devices Improve Functional Class without Normalizing Peak Oxygen Consumption

Benton¹,

Sayer

Nair

et al. 2015

ASAIO Journal

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Heart failure patients supported with left ventricular assist devices (LVAD) enjoy improvements in functional capacity and quality of life. We reasoned that such improvements in exercise capacity should be reflected in an objective increase in peak oxygen consumption as measured by cardiopulmonary exercise testing (CPET). We performed a retrospective review of all recipients of a HeartMate II LVAD at our center from June 2009 to June 2012 who completed CPET. Thirty-seven patients completed CPET an average of 6 months after implantation. Of these, 10 patients had CPET performed before LVAD implantation. Overall, 91.4% of patients improved by at least two New York Heart Association classes, with 34.3% improving by three classes. Postimplant VO2 max was significantly less than predicted (14.7 ± 3.1 vs. 29.8 ± 6.6 ml/kg/min, p < 0.001; percent-predicted 51% ± 12%). For 10 patients with pre- and post-implant studies, VO2 max increased significantly from 11.6 ± 5.0 to 15.4 ± 3.9 ml/kg/min (p = 0.009). VO2 max improves significantly with LVAD support but fails to normalize to predicted values, in spite of improvements in functional class. The severity of preimplantation heart failure does not associate with the degree of VO2 max improvement.

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Assist Devices Improve Functional Class without Normalizing Peak Oxygen Consumption

Benton¹,

Sayer

Nair

et al. 2015

ASAIO Journal

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show abstract

“…(18) Mean peak VO 2 at 3 months increased to a range from 12.66 to 18.3 mL/kg/min across several studies. (18,22–24) By 6 months, peak VO 2 ranged from 12.7 to 18.7 mL/kg/min. (21,24–26) Percentage of predicted norms reflected these increases with percentages increasing from 48–61% at 1 month to 42–66% at 12 months.…”

Section: Describing Functional Progressmentioning

confidence: 99%

Functional Status in Left Ventricular Assist Device–Supported Patients: A Literature Review

Abshire

Himmelfarb

Russell

2014

Journal of Cardiac Failure

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The prevalence of advanced heart failure (HF) is increasing due to the aging population and improvements in HF management strategies. Left Ventricular Assist Device (LVAD) technology and management continue to advance rapidly and it is anticipated that the number of LVAD implants will increase. LVADs have been demonstrated to extend life and improve outcomes in patients with advanced HF. The purpose of this article is to review and synthesize the evidence on impact of LVAD therapy on functional status. Significant functional gains were demonstrated in patients supported by LVAD throughout the first year with most improvement in distance walked and peak oxygen consumption demonstrated in the first 6 months. Interventions to enhance exercise performance have had inconsistent effects on functional status. Poor exercise performance was associated with increased risk of adverse events. Functional status improved with LVAD therapy, though performance remained substantially reduced compared to age adjusted norms. There is tremendous need to enhance our understanding of factors influencing functional outcomes in this high-risk population.

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“…The overriding therapeutic goal of LVAD implantation is to ensure patient survival and guarantee preservation of organ function (2). However, when patients become permanently dependent on the system, a return to everyday life and restoration of an acceptable quality of life acquire crucial significance.…”

mentioning

confidence: 99%

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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Adequate physical and functional performance is an important prerequisite for renewed participation and integration in self-determined private and (where appropriate) professional lives following left ventricular assist device (LVAD) implantation. During cardiac rehabilitation (CR), individually adapted exercise programs aim to increase exercise capacity and functional performance. A retrospective analysis of cardiopulmonary exercise capacity and functional performance in LVAD patients at discharge from a cardiac rehabilitation program was conducted. The results from 68 LVAD patients (59 males, 9 females; 55.9 6 11.7 years; 47 HVAD, 2 MVAD, 15 HeartMate II, 4 HeartMate 3, and 4 different implanting centers) were included in the analysis. Exercise capacity was assessed using a cardiopulmonary exercise test on a bicycle ergometer (ramp protocol; 10 W/min). The 6-min walk test was used to determine functional performance. At discharge from CR (53 6 17 days after implantation), the mean peak work load achieved was 62.2 6 19.3 W (38% of predicted values) or 0.79 6 0.25 W/kg body weight. The mean cardiopulmonary exercise capacity (relative peak oxygen uptake) was 10.6 6 5.3 mL/kg/min (37% of predicted values). The 6-min walk distance improved significantly during CR (325 6 106 to 405 6 77 m; P < 0.01). No adverse events were documented during CR. The results show that, even following LVAD implantation, cardiopulmonary exercise capacity remains considerably restricted. In contrast, functional performance, measured by the 6-min walk distance, reaches an acceptable level. Light everyday tasks seem to be realistically surmountable for patients, making discharge from inpatient rehabilitation possible. Long-term monitoring is required in order to evaluate the situation and how it develops further. Key Words: Heart failure-Left ventricular assist deviceCardiac rehabilitation-Exercise capacity-Functional performance.In the last few years, left ventricular assist devices (LVADs) have been increasingly implanted as treatment for terminal heart failure (HF). Whereas initially these systems were only used as a bridge to transplantation (BTT), today approximately half of all recipients have them implanted as the ultimate destination therapy (DT) (1).The overriding therapeutic goal of LVAD implantation is to ensure patient survival and guarantee preservation of organ function (2). However, when patients become permanently dependent on the system, a return to everyday life and restoration of an acceptable quality of life acquire crucial significance. An optimum build-up of exercise capacity and adequate functional performance is therefore very significant. Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitat...

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Changes in the Functional Status Measures of Heart Failure Patients With Mechanical Assist Devices

Cited by 64 publications

References 17 publications

Left Ventricular Assist Devices Improve Functional Class without Normalizing Peak Oxygen Consumption

Left Ventricular Assist Devices Improve Functional Class without Normalizing Peak Oxygen Consumption

Functional Status in Left Ventricular Assist Device–Supported Patients: A Literature Review

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

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