Exercise in Specific Diseases: Heart Transplantation and Left Ventricular Assist Device

Abstract

The gold standard for treatment of advanced and terminal heart failure (HF) was long considered to be orthotopic heart transplantation (HTX). HTX leads to a significant improvement in the physical capacity of patients, and thus also to a considerable increase in their quality of life. Survival rates are approximately 85%, 70% and 50% after 1, 5 and 10 years, respectively. The lack of donor organs today, however, means that HTX is now unfortunately only an option for a minority of HF patients, with the gap between organ availability and patients requiring treatment increasing. For a long time there were hardly any other options for the treatment of advanced and terminal HF which had a beneficial prognosis except HTX, but over the past two decades enormous progress has been made in the development of so-called mechanical circulatory support systems (MCS), to the extent that they are now considered an alternative to HTX. In most cases the used MCS systems are left ventricular assist devices (LVAD), and the number of LVAD systems implanted now even exceeds the number of HTX performed by quite a margin. Whereas these systems were previously only implanted temporarily, either until the myocardium recovered (bridge to recovery), or until a donor organ became available (bridge to transplant), today they are increasingly being implanted as a long-term solution (destination therapy). Thus, two different surgical procedures are currently available for the long-term treatment of advanced and terminal HF, with considerably different impacts on patients. Over the long-term course, the establishment and maintenance of an acceptable physical capacity is important for both patient groups, in order to improve their quality of life, as well as to enable them to participate in everyday life. In the following, an assessment of functional and cardiopulmonary exercise capacity, as well as the aspects essential to both target groups regarding clinical condition, hemodynamic principles and exercise will be discussed. The final section includes recommendations and peculiarities regarding target-group-specific exercise training.