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096 A protocol for the assessment of heartmate ii patients' fitness to drive
S96
Canadian Journal of Cardiology Volume 27 2011
096 A PROTOCOL FOR THE ASSESSMENT OF HEARTMATE II PATIENTS’ FITNESS TO DRIVE AJ Nunes, S Sinnadurai, RG MacArthur, H Buchholz Edmonton, Alberta BACKGROUND: Canadian fitness to drive guidelines currently suggest that outpatients receiving ventricular assist device (VAD) therapy refrain from the operation of motor vehicles (1). Since smaller, more durable devices now carry the potential for long-term therapy, VAD teams must improve patients’ quality of life (2): helping patients achieve freedom of mobility is integral in this pursuit. Operating within provincial regulations, our center has developed a protocol for assessing patients supported with the HeartMate II device for fitness to drive. METHODS: The present guidelines were developed with respect to Class 5 licensure in the province of Alberta. Initial fitness to drive assessment is performed after 6 weeks of hospital discharge. Evidence of strict compliance and absence of complications (e.g. syncope, defibrillator activation, seizures) must be ascertained prior to any further evaluation. Neurological and electrophysiological consults are requested as necessary. The VAD patient is deemed physically fit to drive when he/she undergoes full physical examination, echocardiography, treadmill-based functional tests, physiotherapist’s evaluation, and is determined stable at New York Heart Association classification I. Following medical clearance, the responsible VAD physician will correspond with his/her respective province’s Driver Fitness and Monitoring Branch indicating surgical procedures performed and the patient’s current status. Follow-up correspondence with provincial authorities will be performed as medically necessary. RESULTS: Currently, there are four HeartMate II patients at our institute who are operating motor vehicles: one patient has been driving for 14.5 months, one patient for 6 months, two patients for 7 months (prior to device explant and transplant, respectively). There have been no self-reported driving incidents or traffic violations. Literature review suggested that driving cessation is associated with increases in depressive symptoms. This may be due to loss of belief in personal control. CONCLUSION: We present a formal fitness to drive assessment guideline for HeartMate II patients. This protocol has been successful at our institute. Safety and efficacy of VAD therapy are continually improving. The VAD team must therefore place an increasing focus on quality of life issues for patients. Facilitating motor vehicle operation is likely to be a critical factor in this respect. REFERENCES:
1. Simpson, C., Ross, D., Dorian, P., et al. CCS Consensus Conference 2003: Assessment of the cardiac patient for fitness to drive and fly_Executive summary. Can J Cardiol 2003; 20:1313-1323. 2. Slaughter, M., Rogers, J., Milano, C., et al. Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device. NEJM 2009; 361:2241-51.
097 COMPARISON OF THE NEUROCOGNITIVE SEQUELAE OF CORONARY ARTERY BYPASS GRAFTING (CABG) USING CONVENTIONAL (CECC) OR MINIMIZED EXTRACORPOREAL CIRCULATION (MinECC) M Perthel, I Daum Bad Segeberg, Germany BACKGROUND: The aim of this study was to investigate the course of neurocognitive function in patients who underwent coronary artery bypass grafting (CABG) with conventional extracorporeal circulation (CECC) compared to minimized extracorporeal circulation (MinECC) and the surgery and patient-specific factors contributing to cognitive impairment. Given recent reports of reduced hemodilution and microemboli exposure in MinECC compared to CECC-systems the study aimed to explore the potential neuroprotective effect of MinECC. METHODS: In a prospective randomised design, a consecutive series of CABG patients assigned to either the CECC (n ⫽ 40) or the MinECC (n ⫽ 38) completed a comprehensive neuropsychological test battery before surgery (T1), and one month (T2) and 6 months (T3) after surgery. Both patient groups were matched on age and education and their performance was compared with matched control subjects. The neurocognitive tasks included measures of mood, speed of information processing, memory, attention and concentration, visuospatial function and executive function in accordance with the guidelines of the consensus statement for cognitive assessment in cardiosurgery (see Stump et al., 1995). RESULTS: The two patient groups did not differ on any cognitive variable at T1. At T2, there was a trend towards significantly better performance of the MinECC group compared to the CECC on measures of memory and speed of information processing. Cognitive status at T2 follow-up correlated significantly with age and mood/affect. Both groups showed a large interindividual variability in the direction of pre-post-changes (i.e. improvement vs. deterioration of neurocognitive performance), with evidence of a higher proportion of patients
Canadian Journal of Cardiology Volume 27 2011
096 A PROTOCOL FOR THE ASSESSMENT OF HEARTMATE II PATIENTS’ FITNESS TO DRIVE AJ Nunes, S Sinnadurai, RG MacArthur, H Buchholz Edmonton, Alberta BACKGROUND: Canadian fitness to drive guidelines currently suggest that outpatients receiving ventricular assist device (VAD) therapy refrain from the operation of motor vehicles (1). Since smaller, more durable devices now carry the potential for long-term therapy, VAD teams must improve patients’ quality of life (2): helping patients achieve freedom of mobility is integral in this pursuit. Operating within provincial regulations, our center has developed a protocol for assessing patients supported with the HeartMate II device for fitness to drive. METHODS: The present guidelines were developed with respect to Class 5 licensure in the province of Alberta. Initial fitness to drive assessment is performed after 6 weeks of hospital discharge. Evidence of strict compliance and absence of complications (e.g. syncope, defibrillator activation, seizures) must be ascertained prior to any further evaluation. Neurological and electrophysiological consults are requested as necessary. The VAD patient is deemed physically fit to drive when he/she undergoes full physical examination, echocardiography, treadmill-based functional tests, physiotherapist’s evaluation, and is determined stable at New York Heart Association classification I. Following medical clearance, the responsible VAD physician will correspond with his/her respective province’s Driver Fitness and Monitoring Branch indicating surgical procedures performed and the patient’s current status. Follow-up correspondence with provincial authorities will be performed as medically necessary. RESULTS: Currently, there are four HeartMate II patients at our institute who are operating motor vehicles: one patient has been driving for 14.5 months, one patient for 6 months, two patients for 7 months (prior to device explant and transplant, respectively). There have been no self-reported driving incidents or traffic violations. Literature review suggested that driving cessation is associated with increases in depressive symptoms. This may be due to loss of belief in personal control. CONCLUSION: We present a formal fitness to drive assessment guideline for HeartMate II patients. This protocol has been successful at our institute. Safety and efficacy of VAD therapy are continually improving. The VAD team must therefore place an increasing focus on quality of life issues for patients. Facilitating motor vehicle operation is likely to be a critical factor in this respect. REFERENCES:
1. Simpson, C., Ross, D., Dorian, P., et al. CCS Consensus Conference 2003: Assessment of the cardiac patient for fitness to drive and fly_Executive summary. Can J Cardiol 2003; 20:1313-1323. 2. Slaughter, M., Rogers, J., Milano, C., et al. Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device. NEJM 2009; 361:2241-51.
097 COMPARISON OF THE NEUROCOGNITIVE SEQUELAE OF CORONARY ARTERY BYPASS GRAFTING (CABG) USING CONVENTIONAL (CECC) OR MINIMIZED EXTRACORPOREAL CIRCULATION (MinECC) M Perthel, I Daum Bad Segeberg, Germany BACKGROUND: The aim of this study was to investigate the course of neurocognitive function in patients who underwent coronary artery bypass grafting (CABG) with conventional extracorporeal circulation (CECC) compared to minimized extracorporeal circulation (MinECC) and the surgery and patient-specific factors contributing to cognitive impairment. Given recent reports of reduced hemodilution and microemboli exposure in MinECC compared to CECC-systems the study aimed to explore the potential neuroprotective effect of MinECC. METHODS: In a prospective randomised design, a consecutive series of CABG patients assigned to either the CECC (n ⫽ 40) or the MinECC (n ⫽ 38) completed a comprehensive neuropsychological test battery before surgery (T1), and one month (T2) and 6 months (T3) after surgery. Both patient groups were matched on age and education and their performance was compared with matched control subjects. The neurocognitive tasks included measures of mood, speed of information processing, memory, attention and concentration, visuospatial function and executive function in accordance with the guidelines of the consensus statement for cognitive assessment in cardiosurgery (see Stump et al., 1995). RESULTS: The two patient groups did not differ on any cognitive variable at T1. At T2, there was a trend towards significantly better performance of the MinECC group compared to the CECC on measures of memory and speed of information processing. Cognitive status at T2 follow-up correlated significantly with age and mood/affect. Both groups showed a large interindividual variability in the direction of pre-post-changes (i.e. improvement vs. deterioration of neurocognitive performance), with evidence of a higher proportion of patients