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Exercise Capacity in Patients with The Total Artificial Heart

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journal contribution
posted on 03.05.2019 by Justin M. Canada, Ronald K. Evans, Antonio Abbate, Ross Arena, Daniel G. Tang, Vigneshwar Kasirajan, Keyur B. Shah
There is a dearth of information regarding the functional abilities of patients with the total artificial heart (TAH). Increased utilization of the TAH and patient discharge to home with the portable unit necessitates a shift in focus to quality of life, which includes quantifying and ultimately optimizing functional capacity. To date only single patient case studies have described the exercise response of the TAH patient. Fourteen patients with the TAH underwent cardiopulmonary exercise testing (CPX) with concurrent analysis of TAH device function. All device settings remained fixed during testing. Peak oxygen consumption (VO2) [0.872 L·min (IQR = 0.828-1.100 L·min)], %-predicted peak VO2 [36% (IQR = 32-42%)], and ventilatory anaerobic threshold (VAT) [0.695 L·min (IQR = 0.542-0.845 L·min)] were markedly reduced in the TAH compared with predicted normal values. Determinants of VO2 using device-generated hemodynamics revealed a blunted cardiac output (CO) (+9% increase) and exaggerated oxygen extraction with exercise. Peak VO2 strongly correlated with resting (R=+0.548, P=0.045), VAT (R=+0.780, P=0.001), and peak exercise CO (R=+0.672, P=0.008). Patients with the TAH have significantly impaired exercise performance. The limitations to CPX performance appear to be related to limited ability of the pump to modulate output for activity and reduced oxygen carrying capacity.

Funding

Keyur B. Shah: Research grants from Thoratec Corporation, Institutional Grants from HeartWare Incorporated, Consulting for HeartWare/ Medtronic. Vigneshwar Kasirajan: Research grants from Syncardia Systems Incorporated, Research grants from Thoratec Corporation. Daniel Tang: Research grants from Syncardia Systems Incorporated, Research grants from Thoratec Corporation, Research grants from HeartWare International Incorporated, and Research grants from Sunshine Heart Incorporated.

History

Publisher Statement

This is a non-final version of an article published in final form in ASAIO journal (American Society for Artificial Internal Organs : 1992), 65(1), 36-42. doi:10.1097/MAT.0000000000000746.

Citation

Canada, J. M., Evans, R. K., Abbate, A., Arena, R., Tang, D. G., Kasirajan, V., & Shah, K. B. (2019). Exercise Capacity in Patients with the Total Artificial Heart. ASAIO journal (American Society for Artificial Internal Organs : 1992), 65(1), 36-42. doi:10.1097/MAT.0000000000000746

Publisher

Lippincott, Williams & Wilkins

Language

en_US

issn

1058-2916

Issue date

01/01/2019

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