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(Circulation. 1997;95:2401-2406.)
© 1997 American Heart Association, Inc.

Articles

Effects of Exercise During Long-term Support With a Left Ventricular Assist Device

Results of the Experience With Left Ventricular Assist Device With Exercise (EVADE) Pilot Trial

Presented in part at the 68th Scientific Sessions of the American Heart Association, Anaheim, Calif, November 13-16, 1995, and published in abstract form (Circulation. 1995;92[suppl I]:I-49).

Brian E. Jaski, MD; Joseph Kim, BS; Richard S. Maly, MS; Kelley R. Branch, BS; Robert Adamson, MD; Laurence K. Favrot, MD; Sidney C. Smith, Jr, MD; Walter P. Dembitsky, MD

From the San Diego (Calif) Cardiac Center (B.E.J., J.K., R.S.M., K.R.B., L.K.F.); the Department of Cardiothoracic Surgery, Donald N. Sharp Memorial Hospital, San Diego, Calif (R.A., W.P.D.); and the Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill (S.C.S.).

Background Long-term implantation of a left ventricular assist device (LVAD) may be a future alternative treatment for end-stage heart failure. The objective of the present study was to determine the hemodynamic effects of supine bicycle exercise and functional capacity during upright treadmill exercise in 10 patients after LVAD implantation placed for refractory heart failure as a bridge to cardiac transplantation.

Methods and Results With supine bicycle exercise, 46±25 days after device placement, heart and LVAD rates increased in parallel from 87±12 to 117±14 bpm and 82±18 to 107±21 bpm, respectively. Peak O₂ consumption was 8.2±1.7 mL O₂·kg^-1·min^-1. Fick systemic blood flow rose from 5.0±1.2 to 7.8±2.5 L/min. Right atrial and pulmonary capillary wedge pressures increased from 6±4 and 5±3 mm Hg to 12±5 and 13±8 mm Hg, respectively. End-diastolic left ventricular dimension increased from 3.9±1.3 to 4.8±1.6 cm; however, right ventricular dimension decreased from 3.2±1.0 to 2.3±0.9 cm. With upright treadmill exercise, peak O₂ consumption was 14.1±2.9 mL O₂·kg^-1·min^-1.

Conclusions This study indicates that exercise during long-term LVAD support is safe and is not limited by right heart decompensation. It also justifies a larger study to examine how exercise after LVAD implantation compares with that after cardiac transplantation.

Key Words: cardiomyopathy • exercise • heart-assist device • heart failure • hemodynamics