A Tale of Two VADs: A Case Study Examining Multidisciplinary Rehabilitation Management Following LVAD/RVAD

Research Objectives: To describe the multidisciplinary rehabilitation management of two patients status post LVAD implantation when complicated by right sided heart failure and RVAD placement.

Design: The design of the study was a case study.

Setting: The setting of this case study was a 746-bed tertiary hospital in Allentown, PA. Both patients were admitted to heart failure service and treated by cardiopulmonary service line which consists of physical therapy, occupation therapy, and phase one cardiac rehabilitation.

Participants: Two patients were included in this case study. Patients were selected based on the criteria of requiring RVAD support following new LVAD implantation.

Interventions: Treatment program consisted of bed mobility, transfer training, balance training, muscle strengthening, LVAD management tasks, assisted cough/deep breathing techniques, energy conservation education, activities of daily living management, and progressive ambulation.

Main Outcome Measures: Outcome measures performed included the Boston University AM-PAC "6-clicks" Inpatient Basic Mobility and Daily Activity Short Forms, six minute walk test, Tinetti Gait and Balance Assessment, grip strength measurement, Montreal Cognitive Assessment, and Kansas City Cardiomyopathy Questionnaire.

Results: Case One received 18 PT sessions, 19 OT sessions, and 19 CR sessions post LVAD implantation during acute care stay. Of these sessions, nine were completed in the presence of RVAD. Patient’s AM-PAC score improved from 7/24 to 17/24 on Basic Mobility Short Form and 10/24 to 18/24 on Daily Activity Short Form. Patient was discharged to the acute inpatient rehabilitation center on hospital day 56.
Case Two received 23 PT sessions, 19 OT sessions, and 8 CR sessions post LVAD implantation. 15 sessions were completed in the presence of RVAD. Improvement in AM-PAC score was documented from 6/24 to 24/24 on both Basic Mobility and Daily Activity Short Form. The progression in functional status allowed this patient to be discharged directly home with home services on hospital day 45.

Conclusions: This case study demonstrates that rehab services can be safety implemented following LVAD implant complicated by RVAD placement when the appropriate multidisciplinary team approach is utilized.

Author(s) Disclosures: No financial disclosures or conflicts of interest.