Kwong Joann, Rizzuto Sandra, Hollander Amanda M, Rivera Jennifer, Dykes John C, Jahadi Ozzie, Murray Jenna, Hollander Seth A
From the Department of Rehabilitation Services, Lucile Packard Children's Hospital Stanford, Palo Alto, California.
Department of Pediatrics (Cardiology), Stanford University, Palo Alto, California.
ASAIO J. 2025 Mar 1;71(3):e41-e45. doi: 10.1097/MAT.0000000000002254. Epub 2024 Jun 13.
Patients supported on ventricular assist devices (VADs) benefit from rehabilitation while awaiting heart transplantation to recover from surgery, prevent deconditioning, and, in most cases, optimize transplant candidacy. With bleeding and neurological dysfunction as the most common VAD complications, the importance of rehabilitation dramatically increases when a patient on a VAD also suffers from a neurological injury. The rehabilitation needs for cardiac conditioning and neurological reeducation are not the same. Patients with severe neurological deficits require intense rehabilitation that often includes base-of-support challenges, usage of bolsters and balls, partial weight-bearing treadmill training, and assumption of various body positions in prone, kneeling, or quadruped for neuromotor reeducation. However, some devices are more conducive to rehabilitation than others. For children supported by the CentriMag in particular, rehabilitation is challenged by short cannula tubing, an external motor, a large interface, and an intensive care unit (ICU) admission. We report a safe and successful physical therapy course of a pediatric stroke patient with a diagnosis of Ebstein's anomaly supported by a CentriMag right VAD (RVAD) while awaiting heart transplant in the ICU.
接受心室辅助装置（VAD）支持的患者在等待心脏移植期间受益于康复治疗，以从手术中恢复、防止身体机能下降，并且在大多数情况下，优化移植候选资格。由于出血和神经功能障碍是VAD最常见的并发症，当使用VAD的患者同时患有神经损伤时，康复的重要性会显著增加。心脏功能训练和神经功能再教育的康复需求并不相同。患有严重神经功能缺损的患者需要强化康复治疗，通常包括支撑面挑战、使用靠垫和球、部分负重跑步机训练，以及在俯卧、跪姿或四足姿势下采取各种身体姿势进行神经运动再教育。然而，一些装置比其他装置更有利于康复。特别是对于由CentriMag支持的儿童，短套管、外部电机、大接口和重症监护病房（ICU）入院对康复构成了挑战。我们报告了一名诊断为埃布斯坦畸形的小儿中风患者在ICU等待心脏移植期间，由CentriMag右心室辅助装置（RVAD）支持的安全且成功的物理治疗过程。
