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Increasing Pump Speed During Exercise Training Improves Exercise Capacity in Children with Ventricular Assist Devices
Danielle S Burstein1, Michael G Mcbride1, Joseph W Rossano1
1From the Division of Cardiology, Children's Hospital of Philadelphia; Philadelphia, Pennsylvania.
Insights
Increasing ventricular assist device (VAD) pump speed during exercise training significantly improves exercise capacity in children awaiting heart transplantation. This approach enhances aerobic and working capacity without adverse events, offering a promising strategy for pediatric cardiac rehabilitation.
Area of Science:
- Pediatric cardiology
- Cardiovascular engineering
- Rehabilitation medicine
Background:
- Exercise rehabilitation is crucial for children with ventricular assist devices (VADs) awaiting heart transplantation (HT).
- Optimizing exercise capacity during VAD support is essential for improving patient outcomes.
- Current exercise protocols may not fully leverage VAD capabilities.
Purpose of the Study:
- To investigate if increasing VAD pump speed during exercise testing and training enhances exercise capacity in pediatric patients.
- To compare the effects of fixed versus increasing VAD pump speed on exercise parameters.
Main Methods:
- A single-center cohort study comparing historical (fixed VAD pump speed) and prospective (increasing VAD pump speed) groups.
- Serial cardiopulmonary exercise testing (CPET) was used to assess exercise capacity.
- Participants were children with continuous-flow VADs, including those with dilated cardiomyopathy and single ventricle physiology.
Main Results:
- The group with increased VAD pump speed showed a 42% increase in maximal oxygen consumption (VO2) and a 49% increase in maximal work.
- The fixed pump speed group experienced a 3% decrease in maximal VO2 and a 13% increase in maximal work.
- No adverse events were reported in either the fixed or increased pump speed cohorts.
Conclusions:
- Increasing VAD pump speed during exercise training significantly improves aerobic and physical working capacity in pediatric VAD patients.
- This strategy is effective regardless of underlying cardiac physiology (single or biventricular).
- Further research with larger cohorts is recommended to validate these findings for pediatric cardiac rehabilitation.
Abstract:
Exercise rehabilitation during pediatric ventricular assist device (VAD) support aims to improve musculoskeletal strengthening while awaiting heart transplantation (HT). This study aimed to determine whether increasing VAD pump speed during exercise testing and training improves exercise capacity. A single-center cohort study was performed comparing changes in exercise capacity on serial cardiopulmonary exercise testing (CPET) after exercise training at a fixed VAD pump speed (historical cohort from 2014 to 2017) compared with a prospective cohort (2017-2019) who underwent increasing pump speed during exercise training. All children were supported with intracorporeal continuous-flow VAD. Four subjects (13 ± 2.8 years) were included in the historical cohort, and 6 subjects (14 ± 1.7 years) were enrolled in the prospective cohort. Ninety percent had dilated cardiomyopathy, and one had single ventricle Fontan physiology. Baseline maximal oxygen consumption (VO2) was 19 ± 6.3 ml/kg/min. After exercise training with increased pump speed, there was substantial improvement in aerobic capacity (maximal VO2 increased 42% vs. decreased 3%, respectively) and working capacity (maximal work increased 49% vs. 13%, respectively) compared with fixed pump speed. There were no adverse events reported in either the fixed or increased pump speed cohorts. Increasing VAD pump speed during exercise training results in substantial improvement in both physical working and aerobic capacity compared a fixed pump speed in children on VAD support regardless of single or biventricular ventricle physiology. Further study of a larger cohort is needed to validate these findings to improve the approach to pediatric cardiac rehabilitation in this population.
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