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Safety and Effectiveness of Exercise Training in Patients with Continuous Flow Ventricular Assist Devices
Abstracts the accuracy and clinical reliability of the estimated flow in determining CO in patients (pts) with an HM-LVAD. Methods and Materials: Cardiac catheterization (RHC) was performed in 25 pts with an HM-VAD. Pts with significant aortic insufficiency or presumed HM-VAD thrombosis were excluded. The average of 3 consecutive thermodilution CO measurements was made while simultaneously recording the flow-estimate on the HM-LVAD display monitor. Results: The indication for RHC was per clinical protocol (n¼19) or right heart failure (n¼6). The mean HM-VAD parameters were: speed 9600 rpm, flow 5.7⫾0.8 l/min, power 6.9⫾0.7 watts, and pulsatility index 4.8⫾0.8. A weak correlation was seen between CO and estimated flow (r¼0.38; p¼0.05) with the poorest correlation seen in those with a lower cardiac index (o2.5 L/min/m2; n¼13)(r¼0.05, p¼0.88). Correlation was unaffected by the presence (n¼14) or absence (n¼11) of aortic valve opening by echo (r¼0.44 and 0.37, respectively; p¼NS). Estimated flow was more likely to overestimate (68%) than underestimate (32%) CO. Bland-Altman analyses comparing CO to estimated flow revealed a mean bias of 0.32 l/min with wide 95% limits of agreement of 2.6 to -2.0 l/min.
S181 changes in training duration and intensity during the rehabilitation were documented. A subgroup of 15 patients underwent two spiroergometry tests: at the beginning and end of the rehabilitation. Any adverse event related to training was also recorded. Results: Patients were admitted to rehabilitation 48⫾38 days after CFVAD implantation. During a rehabilitation period of 32⫾6 days the patients performed 9.6⫾4.3 sessions of bicycle ergometer training, 6.4⫾3.1 sessions of strength training, 8.6⫾4.9 walking sessions and 15.5⫾6.0 gymnastic sessions. A considerable increase in duration (19⫾4 vs. 14⫾2 min) and intensity of bicycle training (module #6.2⫾2.8 vs. module #2.0⫾1.9) was observed. Muscular strength (weight lifted) also increased for all muscle groups. The spiroergometry tests showed an increase of the maxVO2 (14.5⫾5.2 vs.11.3⫾4.1 ml/kg/ min) and the maximal power (61.5⫾24.6 vs. 44.4⫾17.6 W). Only one training-related complication (non-sustained ventricular tachycardia) was observed. Conclusions: Exercise training in CF-VAD patients demonstrated to be possible, effective and safe. Physical functional capabilities of CFVAD patients recover considerably during rehabilitation. 483 The Effect of Percuatneous Lead Placement on Drive Line Exit Site Infections in HeartMate II Patients W.H. Perry, N.M. Chelikani, T.A. Snyder, K.E. Nelson, P.J. Kannaly, J.S. Chaffin, C.C. Elkins, D.A. Horstmanshof, J.W. Long. Integris Advanced Cardiac Care Integris Baptist Medical Center, Oklahoma City, OK.
Conclusions: Flow estimates correlate poorly with cardiac output and should not be relied upon as a surrogate for CO in HM-VAD pts. A low threshold for invasive CO measurement is warranted particularly in those whose clinical condition is consistent with a low F1 CO state. 482 Safety and Effectiveness of Exercise Training in Patients with Continuous Flow Ventricular Assist Devices F. Moscato,1,3 G. Danzinger,1 M. Kaferb ack, ¨ ¨ 1 T. Lackner,4 D. Zimpfer,2 H. Schima,1,2,3 C. Marko.4 1Center for Medical Physics and Biomedical Engineering Medical University of Vienna, Vienna, Austria; 2Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; 3Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; 4Rehabilitation Clinic Felbring, Muthmannsdorf, Austria. Purpose: Continuous flow ventricular assist devices (CF-VADs) are used nowadays in an increasing number of heart failure patients as a bridge or alternative to heart transplantation. Exercise training could improve patient quality of life, however its safety and effectiveness for CF-VAD patients seems not investigated systematically yet. Aim of this study was to analyze exercise training in CF-VAD patients during rehabilitation. Methods and Materials: Data collected between 2010 and 2012 during rehabilitation of 41 CF-VAD patients (age 54.8⫾11.6 y, female 20%) was retrospectively analyzed. The exercise training consisted of bicycle ergometer training (12 modules of increasing intensity), strength training for five muscle groups of the lower limbs, training in walking and gymnastic groups. The number of training sessions as well as the
Purpose: It has been suggested that aligning the junction of the silicon exterior of the HeartMate II drive line and the flocked portion of the lead with skin level, ‘‘Buried’’, as opposed to leaving 2-3 inches of the flocking exposed above the skin, ‘‘Unburied’’ reduced DLES infections. Thus, we examined DLES infection rates and causes in a single center, retrospective, non-randomized review. Methods and Materials: We compared DLES infection incidence, cause of infection (poor wound healing vs. trauma), time to 1st infection, requirement for advanced measures with the 2 DLES placements in Thoratec HeartMate II recipients. Statistical comparisons were performed using Statica (Statsoft). For this study, we defined a DLES infection as at least one positive wound culture. Results: Figure 1 shows the freedom from DLES infections for the 2 approaches. Significantly more, 33% (16/48)) of Unburied had DLES infections than 18% (17/94) of Buried, and the infection duration was longer, 500 vs. 175 days, respectively. The average time to 1st infection was significantly longer, 13 months, for the Unburied vs 7 months for the Buried, related to cause of infection: poor wound healing in 59% of the Buried DLES infections (10/17) vs. 38% (6/16) for the Unburied. Of the 16 Unburied DLES infections, 11 required wound vac, 7 surgical revision, and 3 pump replacements, vs. 9, 7, and 0 respectively for the Buried approach.
Conclusions: Using the Buried approach may reduce the incidence, severity, and duration of DLES infection, yet, a portion of patients still
S181 changes in training duration and intensity during the rehabilitation were documented. A subgroup of 15 patients underwent two spiroergometry tests: at the beginning and end of the rehabilitation. Any adverse event related to training was also recorded. Results: Patients were admitted to rehabilitation 48⫾38 days after CFVAD implantation. During a rehabilitation period of 32⫾6 days the patients performed 9.6⫾4.3 sessions of bicycle ergometer training, 6.4⫾3.1 sessions of strength training, 8.6⫾4.9 walking sessions and 15.5⫾6.0 gymnastic sessions. A considerable increase in duration (19⫾4 vs. 14⫾2 min) and intensity of bicycle training (module #6.2⫾2.8 vs. module #2.0⫾1.9) was observed. Muscular strength (weight lifted) also increased for all muscle groups. The spiroergometry tests showed an increase of the maxVO2 (14.5⫾5.2 vs.11.3⫾4.1 ml/kg/ min) and the maximal power (61.5⫾24.6 vs. 44.4⫾17.6 W). Only one training-related complication (non-sustained ventricular tachycardia) was observed. Conclusions: Exercise training in CF-VAD patients demonstrated to be possible, effective and safe. Physical functional capabilities of CFVAD patients recover considerably during rehabilitation. 483 The Effect of Percuatneous Lead Placement on Drive Line Exit Site Infections in HeartMate II Patients W.H. Perry, N.M. Chelikani, T.A. Snyder, K.E. Nelson, P.J. Kannaly, J.S. Chaffin, C.C. Elkins, D.A. Horstmanshof, J.W. Long. Integris Advanced Cardiac Care Integris Baptist Medical Center, Oklahoma City, OK.
Conclusions: Flow estimates correlate poorly with cardiac output and should not be relied upon as a surrogate for CO in HM-VAD pts. A low threshold for invasive CO measurement is warranted particularly in those whose clinical condition is consistent with a low F1 CO state. 482 Safety and Effectiveness of Exercise Training in Patients with Continuous Flow Ventricular Assist Devices F. Moscato,1,3 G. Danzinger,1 M. Kaferb ack, ¨ ¨ 1 T. Lackner,4 D. Zimpfer,2 H. Schima,1,2,3 C. Marko.4 1Center for Medical Physics and Biomedical Engineering Medical University of Vienna, Vienna, Austria; 2Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; 3Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; 4Rehabilitation Clinic Felbring, Muthmannsdorf, Austria. Purpose: Continuous flow ventricular assist devices (CF-VADs) are used nowadays in an increasing number of heart failure patients as a bridge or alternative to heart transplantation. Exercise training could improve patient quality of life, however its safety and effectiveness for CF-VAD patients seems not investigated systematically yet. Aim of this study was to analyze exercise training in CF-VAD patients during rehabilitation. Methods and Materials: Data collected between 2010 and 2012 during rehabilitation of 41 CF-VAD patients (age 54.8⫾11.6 y, female 20%) was retrospectively analyzed. The exercise training consisted of bicycle ergometer training (12 modules of increasing intensity), strength training for five muscle groups of the lower limbs, training in walking and gymnastic groups. The number of training sessions as well as the
Purpose: It has been suggested that aligning the junction of the silicon exterior of the HeartMate II drive line and the flocked portion of the lead with skin level, ‘‘Buried’’, as opposed to leaving 2-3 inches of the flocking exposed above the skin, ‘‘Unburied’’ reduced DLES infections. Thus, we examined DLES infection rates and causes in a single center, retrospective, non-randomized review. Methods and Materials: We compared DLES infection incidence, cause of infection (poor wound healing vs. trauma), time to 1st infection, requirement for advanced measures with the 2 DLES placements in Thoratec HeartMate II recipients. Statistical comparisons were performed using Statica (Statsoft). For this study, we defined a DLES infection as at least one positive wound culture. Results: Figure 1 shows the freedom from DLES infections for the 2 approaches. Significantly more, 33% (16/48)) of Unburied had DLES infections than 18% (17/94) of Buried, and the infection duration was longer, 500 vs. 175 days, respectively. The average time to 1st infection was significantly longer, 13 months, for the Unburied vs 7 months for the Buried, related to cause of infection: poor wound healing in 59% of the Buried DLES infections (10/17) vs. 38% (6/16) for the Unburied. Of the 16 Unburied DLES infections, 11 required wound vac, 7 surgical revision, and 3 pump replacements, vs. 9, 7, and 0 respectively for the Buried approach.
Conclusions: Using the Buried approach may reduce the incidence, severity, and duration of DLES infection, yet, a portion of patients still