Introduction Ventricular assist devices (VAD) are used to support patients with end stage heart failure. Rehabilitation in adults with a VAD is well established; improving cardiorespiratory fitness and strength. The Berlin Heart, an extracorporeal VAD, is used as a bridge to heart transplant in children. There is no evidence to guide rehabilitation in this population, and the impact on development and post-transplant recovery requires investigation. This study aimed to demonstrate the feasibility of rehabilitation in paediatric VAD patients as well as its significance in optimizing patients for transplant.
Case summary We present a case series discussing the rehabilitation of three children supported on Berlin Heart. The patients were aged between 16 and 50 months, two were males and admission diagnoses included dilated cardiomyopathy and congenital aortic stenosis. At VAD implantation, the patients were significantly deconditioned, unable to mobilise independently and displayed delayed gross motor skills. The number of days bridged on VAD ranged from 310–392.
Rehabilitation, including active-assisted and functional exercises, started on day one post VAD insertion. Two children sat over the edge of bed whilst intubated and all were sitting out of bed by day 18. The patients regularly attended the gym once discharged to the ward. Gym rehabilitation focused on developmental play, strengthening, and exercise tolerance; involving crawling, stairs, and cycling. No adverse events were reported during rehabilitation sessions. At the time of transplant each child was independently mobile, displayed age-appropriate motor skills, and tolerated 30–60 minute gym sessions.
Conclusion All children improved exercise tolerance and motor skills whilst on the Berlin Heart. This case series suggests that rehabilitation in paediatric VAD patients is safe. From our experience optimizing pre-transplant physical status helps to facilitate post-transplant recovery. This small study highlights the need for further research, including investigation into standardised outcome measures and optimal levels of activity.
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