Exercise capacity in an individual with LVAD explantation without heart transplantation

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Patterson, Jeremy A.
Amick, Ryan Zackary
Farhoud, Hussam

Patterson, Jeremy A., Amick, Ryan Z., Farhoud, Hussam H. 2010. Exercise capacity in an individual with LVAD explantation without heart transplantation. Journal of Cardiopulmonary Rehabilitation and Prevention. Jul-Aug; 30(4): 231-4.


PURPOSE: Left ventricular assist devices (LVADs) have become a viable treatment alternative to heart transplantation, in some instances providing for a level of improvement of native heart function to allow for device explantation. The aim of this case study was to describe changes in physical work capacity following 9 months of LVAD support.

CLINICAL CASE: The patient described here was diagnosed with idiopathic dilated cardiomyopathy and demonstrated worsening heart failure over a 5-year period with a maximum left ventricular end-diastolic diameter of 8.99 cm and an ejection fraction of 15% to 25%. Upon implantation of an LVAD, central hemodynamic function improved and the device was removed after 9 months of support. Left ventricular diastolic and systolic diameter decreased by 39.8% and more than 30%, respectively. The left atrium decreased by 21.7% and ejection fraction was maintained by the LVAD and stabilized at 20%. Four months postexplantation, a cycle ergometry graded cardiopulmonary exercise test was performed. Exercise began at 0 W and increased 25 W per 3-minute stage.

RESULTS: The patient showed improvement in peak aerobic capacity when compared to pre-LVAD cardiopulmonary stress tests. Peak oxygen uptake increased from pre-LVAD measures of 11.8 mL · kg−1 · min−1 to 17.0 mL · kg−1 · min−1. Time to maximal exertion increased from 5 minutes 27 seconds to 15 minutes.

CONCLUSION: Results of this case study indicate that significant improvements in native heart function leading to an increased ability to perform work is possible following a period of mechanical unloading through LVAD support.

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