Kourek Christos, Karatzanos Eleftherios, Nanas Serafim, Karabinis Andreas, Dimopoulos Stavros
Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Attica, Greece.
Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece.
World J Transplant. 2021 Nov 18;11(11):466-479. doi: 10.5500/wjt.v11.i11.466.
Heart transplantation remains the gold standard in the treatment of end-stage heart failure (HF). Heart transplantation patients present lower exercise capacity due to cardiovascular and musculoskeletal alterations leading thus to poor quality of life and reduction in the ability of daily self-service. Impaired vascular function and diastolic dysfunction cause lower cardiac output while decreased skeletal muscle oxidative fibers, enzymes and capillarity cause arteriovenous oxygen difference, leading thus to decreased peak oxygen uptake in heart transplant recipients. Exercise training improves exercise capacity, cardiac and vascular endothelial function in heart transplant recipients. Pre-rehabilitation regular aerobic or combined exercise is beneficial for patients with end-stage HF awaiting heart transplantation in order to maintain a higher fitness level and reduce complications afterwards like intensive care unit acquired weakness or cardiac cachexia. All hospitalized patients after heart transplantation should be referred to early mobilization of skeletal muscles through kinesiotherapy of the upper and lower limbs and respiratory physiotherapy in order to prevent infections of the respiratory system prior to hospital discharge. Moreover, all heart transplant recipients after hospital discharge who have not already participated in an early cardiac rehabilitation program should be referred to a rehabilitation center by their health care provider. Although high intensity interval training seems to have more benefits than moderate intensity continuous training, especially in stable transplant patients, individualized training based on the abilities and needs of each patient still remains the most appropriate approach. Cardiac rehabilitation appears to be safe in heart transplant patients. However, long-term follow-up data is incomplete and, therefore, further high quality and adequately-powered studies are needed to demonstrate the long-term benefits of exercise training in this population.
心脏移植仍然是终末期心力衰竭（HF）治疗的金标准。由于心血管和肌肉骨骼改变，心脏移植患者的运动能力较低，从而导致生活质量差和日常自理能力下降。血管功能受损和舒张功能障碍导致心输出量降低，而骨骼肌氧化纤维、酶和毛细血管减少导致动静脉氧差，从而导致心脏移植受者的峰值摄氧量降低。运动训练可提高心脏移植受者的运动能力、心脏和血管内皮功能。预康复阶段进行规律的有氧运动或联合运动对等待心脏移植的终末期HF患者有益，以便维持较高的体能水平并减少随后出现的并发症，如重症监护病房获得性肌无力或心脏恶病质。心脏移植后的所有住院患者都应通过上下肢运动疗法和呼吸物理治疗尽早进行骨骼肌动员，以预防出院前的呼吸系统感染。此外，所有出院后尚未参加早期心脏康复计划的心脏移植受者应由其医疗保健提供者转介至康复中心。尽管高强度间歇训练似乎比中等强度持续训练有更多益处，尤其是在稳定的移植患者中，但根据每个患者的能力和需求进行个性化训练仍然是最合适的方法。心脏康复对心脏移植患者似乎是安全的。然而，长期随访数据不完整，因此，需要进一步开展高质量、有足够样本量的研究来证明运动训练对该人群的长期益处。
