Physical Capacity in LVAD Patients: Hemodynamic Principles, Diagnostic Tools and Training Control

Reiss, Nils; Schmidt, Thomas A.; Workowski, Anke; Willemsen, Detlev; Schmitto, Jan D.; Haverich, Axel; Bjarnason-Wehrens, Birna

doi:10.5301/ijao.5000529

Cited by 19 publications

(21 citation statements)

References 64 publications

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“…Setting the LVAD pump speed (at rest) generally involves a compromise between suction prevention, optimal leftventricular unloading and aortic valve opening. On one hand, sufficient TCO must be generated, but on the other possible complications (e.g., aortic valve fusion or arrhythmias) must be avoided (13,32,33). The studies included used five different continuousflow pumps in total.…”

Section: Pump Types and Settingsmentioning

confidence: 99%

“…TCO comprises LVAD flow and ejection through the aortic valve (11,13,26). The proportions can differ depending on the myocardial residual function, especially with increasing physical exercise (27,42).…”

Section: Tcomentioning

confidence: 99%

“…The right-ventricular systolic function is also crucial (10,13). Through an increased pump speed and during physical exercise, venous reflux is considerably increased.…”

Section: Role Of the Residual Myocardial Functionmentioning

confidence: 99%

“…As the underlying disease also limits the output via the aortic valve, the total cardiac output (TCO) cannot be sufficiently increased. Consequentially the prerequisites for good exercise capacity are not met as they are in healthy persons (13).…”

Section: Introductionmentioning

confidence: 99%

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Effects of pump speed changes on exercise capacity in patients supported with a left ventricular assist device—an overview

et al. 2018

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The implantation of left ventricular assist devices (LVAD) has been established as a successful treatment for terminal heart failure (HF) for many years. Patient benefits include significantly improved survival, as well as improved quality of life. However, peak exercise capacity following LVAD implantation remains considerably restricted. This could be due to the predominate use of continuous-flow pumps, which operate at a fixed rotational speed and do not adapt to exercise conditions. Therefore, current research is focused on whether, and to what extent, adaptations in pump speed can influence and improve patient exercise capacity. We performed a systematic PubMed literature search on this topic, and found 11 relevant studies with 161 patients. Exercise time, peak work load, total cardiac output (TCO), peak oxygen consumption (peak VO) and, if available, values at the anaerobic threshold (AT) were all taken into consideration. Possible complications were documented. This paper aims to compare the results from these studies in order to discuss the effects of pump speed adaptations on exercise capacity.

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Section: Pump Types and Settingsmentioning

confidence: 99%

Section: Tcomentioning

confidence: 99%

“…The right-ventricular systolic function is also crucial (10,13). Through an increased pump speed and during physical exercise, venous reflux is considerably increased.…”

Section: Role Of the Residual Myocardial Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of pump speed changes on exercise capacity in patients supported with a left ventricular assist device—an overview

et al. 2018

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“…Physical capacity essentially depends on generated CO and/or arteriovenous oxygen difference (avDO 2 ), which together contribute to muscular oxygen supply . In LVAD patients, total CO comprises pump flow on the one hand, and native output via the aortic valve on the other . Pump flow is particularly limited by preload and afterload, by fixed revolutions per minute (rpm) and by pump type.…”

mentioning

confidence: 99%

Changes in Total Cardiac Output and Oxygen Extraction During Exercise in Patients Supported With an HVAD Left Ventricular Assist Device

et al. 2018

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Following implantation of a left ventricular assist device (LVAD), acceptable functional performance is now being achieved; however, peak VO and peak work load (watts) remain considerably limited. Maximum physical capacity is essentially dependent on generated cardiac output (CO) and arteriovenous oxygen difference (avDO ). We investigated the changes in CO and avDO during exercise in LVAD patients with an HVAD pump (HeartWare Inc., Framingham, MA, USA). Approximately 6 weeks after implantation, 20 patients (100% male, 60.8 ± 7.3 years old, BMI 25.7 ± 3.3) underwent a six-minute walk test (6MWT), a cardiopulmonary exercise test (CPET), and noninvasive hemodynamic measurement. The mean six-minute walking distance (6MWD) was 403 m (68% of predicted), and mean peak VO was 10.9 mL/kg/min (39% of predicted). Mean total CO improved from 3.8 L at rest to 7.0 L at maximum exercise. The mean avDO increased from 7.4 mL/dL (44% of oxygen content) at rest to 13.2 mL/dL (75% of oxygen content) at maximum exercise. There was a significant increase in both total CO (P < 0.01) and avDO (P < 0.05) between rest and sub-maximum exercise. As exercise levels increased, however, no further significant changes were achieved. Long-term studies, especially in combination with exercise programs, would be desirable in order to observe the development of these parameters.

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Exercise training in patients with ventricular assist devices: a review of the evidence and practical advice. A position paper from the Committee on Exercise Physiology and Training and the Committee of Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Adamopoulos

Corrà

Laoutaris

et al. 2018

European J of Heart Fail

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Exercise training (ET) and secondary prevention measures in cardiovascular disease aim to stimulate early physical activity and to facilitate recovery and improve health behaviours. ET has also been proposed for heart failure patients with a ventricular assist device (VAD), to help recovery in the patient's functional capacity. However, the existing evidence in support of ET in these patients remains limited. After a review of current knowledge on the causes of the persistence of limitation in exercise capacity in VAD recipients, and concerning the benefit of ET in VAD patients, the Heart Failure Association of the European Society of Cardiology has developed the present document to provide practical advice on implementing ET. This includes appropriate screening to avoid complications and then starting with early mobilisation, ET prescription is individualised to meet the patient's needs. Finally, gaps in our knowledge are discussed.

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Physical Capacity in LVAD Patients: Hemodynamic Principles, Diagnostic Tools and Training Control

Cited by 19 publications

References 64 publications

Effects of pump speed changes on exercise capacity in patients supported with a left ventricular assist device—an overview

Effects of pump speed changes on exercise capacity in patients supported with a left ventricular assist device—an overview

Changes in Total Cardiac Output and Oxygen Extraction During Exercise in Patients Supported With an HVAD Left Ventricular Assist Device

Exercise training in patients with ventricular assist devices: a review of the evidence and practical advice. A position paper from the Committee on Exercise Physiology and Training and the Committee of Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

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