Authors (including presenting author) :
Ching CM(1), Ng SW(1), Do K(1), Lam SL(1), Hui YC(1), Wong LY(1)
Affiliation :
(1)Department of Cardiothoracic Surgery, Queen Mary Hospital (QMH)
Introduction :
Heart transplantation is the last resort for the end-stage heart failure patients if pharmaceutical options are exhausted. However, due to limited donor, many of them pass away while waiting. QMH introduce the use of Biventricular Ventricular Assist Device (BiVAD) since 2011 to help this group of patient as a bridge to transplant. However, after implantation of BiVAD, patients will require a prolonged hospital stay and are expected to face extreme stress. A multidisciplinary mobilization program was designed to enhance their physical and psychological readiness for heart transplantation.
Objectives :
Physical and psychosocial status improve with exercise is undoubtedly. Patients with BiVAD are usually in critical physical condition before implant. By mobilization exercise, increase in muscle strength and hence increase the independence and physically readiness of heart transplantation is expected. Psychosocially, mobilization exercise can improve patients’ exposure to social environment and hence boosted their mental morale.
Methodology :
Having a multidisciplinary collaboration on mobilization program is the key to success. In physical aspect, physiotherapist will support patients’ muscle by training such as passive cycling, standing and even walking exercise. Occupational therapist will tailor-made a BiVAD cannula securing device to securing the cannula location while exercising. Dietitian will provide expert opinion for an all-rounded nutritional support for energy and muscle gain. Nurses will coordinate all these activities and tackle device related complications. Psychologically, clinical psychiatrist will counsel the patients to psychologically prepare them for heart transplantation. In-hospital teachers will provide teenaged patient a continuation of education. Nurses will arrange flexible visiting hours for relatives and friends to restore social life. Mobilization outside ward area with relative and nurses is even possible to further increase their psychosocial well-being.
Result & Outcome :
The average duration of support from year 2011-15 is 39 days (range from 1 to 197 days). Among them 43% survive to recovery or transplant. The figure improved to an average of 90 days (range from 7 to 236 days) for year 2016-18 with a survival rate of 65%. Conclusion: With multidisciplinary collaboration, mobilizations of BiVAD patients not only increase patients’ independence, but also promote their mental healthiness. Ultimately we aim to provide them a improved quality of life with greater opportunity for receiving heart transplantation.
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