At the time of this writing, two patients at the author's facility have undergone TAH implantation with one of those patients successfully receiving orthotopic heart transplantation and being discharged home.
Six days after admission he underwent implantation of the CardioWest TAH.
However because of the recent initiation and clinical implementation of this device at the Cleveland Clinic, no specific PT guidelines for patients with TAH had been established.
Documentation regarding the medication adjustment was not clear; however for purposes of comparison, as a result of the cardiectomy and TAH implantation, medications need to be directed peripherally as opposed to patients who receive LVAD may still receive centrally acting cardiovascular agents such as positive inotropes.
(6), (7), (18) Monitoring fill volumes are unique to patients with TAH as these volumes will help dictate cardiac output.
Despite the TAH implantation, the evaluation findings are consistent with those reported in the literature for patients with LVAD placement.
Because of the recent initiation and clinical implementation of this device at this author's facility, no PT guidelines had been established for patients with TAH. The patient's presentation however was similar to those referenced in the literature for patients with heart failure and circulatory assist devices.
With reference to the specific features of the TAH, the heart rate is fixed with increased cardiac output occurring as a result of increasing preload.
However, it appears that the TAH mechanism, such as a fixed heart rate and maximal stroke volume, maybe responsible for some of the cardiovascular responses measured during exercise with this patient.
Since this patient's response to exercise is consistent with literature for patients with LVAD, it appears that following these established parameters in the literature is appropriate for patients with TAH. However, given the limitation of a single case report and the mechanical differences between LVAD and TAH, further study on these physiological aspects is warranted in the future to fully determine management guidelines.
Poor thoracic posture while seated may have stressed the drive lines exiting the body, compromising TAH function.