Heart Transplantation

• Heart Transplantation:

  • only need to know about the most common surgical technique - bi-caval technique
  • surgeon removes the heart, but leaves the left atrium, aorta, pulmonary artery, superior vena cava, inferior vena cava behind, and the new heart is attached to those points
  • due to surgical denervation, the new hearts sinoatrial node is not connected to the brain via the autonomic nervous system, so the new resting heart rate is usually around 100 to 120 bpm, due to heart rate not being suppressed by the parasympathetic branch
  • normally high heart rate is a contraindication for exercise, but its normal in this instance

  
• Key Physiotherapy Perspectives

  • using heart rate to prescribe exercise intensity
  • altered vascular endothelium, pulmonary function, skeletal muscle morphology and ventricular function
  • immunosuppression
  • episodes of rejection
  • decreased bone mineral density
• Progress:

  • opt out instead of opt in now
  • increased time of preserving organs (TransMedic)
  • can now restart a dead heart from a donor
• Cardiac Rehabilitation:

  • Cochrane Database of Systematic Reviews Exercise-based cardiac rehabilitation in heart transplant recipients (review) published April 2017
  • 10 RCTs, 300 participants, mean age 54.4 years
  • findings:
  • exercise based cardiac rehabilitation improves exercise capacity
  • cardiac rehab appears safe for this population
  • more research needed to demonstrate longer term benefits and impact on clinical and patients outcomes (QoL and healthcare costs)