The Rehabilitation of Advanced Heart Failure Patients after Left Ventricular Assist Device: A Narrative Review.

As an increasing number of patients with advanced heart failure are receiving a Left Ventricular Assist Device (LVAD) as either destination therapy or bridge to transplantation, there is increasing attention on functional outcomes and quality of life after LVAD implantation. Rehabilitation providers in the acute inpatient rehabilitation setting increasingly will treat patients with LVAD and should understand the exercise physiology, medical management, rehabilitation considerations, and outcomes after rehabilitation for patients with LVAD. The purpose of this paper is to provide the physiatrist with a comprehensive understanding of the rehabilitation of advanced heart failure patients with LVAD. The changes in relevant organ system physiology and exercise physiology after LVAD will be summarized. Safety of rehabilitation and program considerations for acute inpatient rehabilitation will be reviewed. Recommendations for medical management and prevention of secondary complications seen in LVAD patients are also outlined. Finally, there will be a discussion of outcomes after acute inpatient rehabilitation, the dual diagnosis of stroke and LVAD, and the long-term cognitive, functional and quality of life outcomes after LVAD placement.