Associazione Nazionale Medici Cardiologi Ospedalieri




Domanskaya Ella Palermo (Palermo) – Ismett Irccs | Enea Giuseppe Palermo (Plalermo) – Ismett Irccs

The complexity of care of the patients affected by advanced heart failure (AHF)  requires a dedicated team led by cardiologists and consists of nurses, physical therapists, patient care coordinator, nurse educator, dietician, anesthesiologists, and perfusionists.

Multidisciplinary team “ has been shown to reduce the risk of hospitalization, death, and health care costs in randomized controlled trials”1.

AHF is characterized by the progressive worsening of the clinical conditions of the patient unresponsive to the optimal medical therapy. Therefore, the  short-term mechanical circulatory supports as Intraaortic Balloon Pump (IABP) may represent a valid strategy for optimizing and bridging the patient affected by AHF to the heart transplant2.

A 52 years old lady with the diagnosis of the AHF and associated cachexia and sarcopenia has admitted in emergency. Despite of the high dose of inotrope  severe hypotension required a IABP support to provide an adequate organs perfusion.

Left ventricular assist device therapy has been rule out: the patient originated from the other country lives alone so no caregiver may be designed and trained to provide a support during the period following the LVAD’s implantation.

For over than 130 days  the patient well tolerates a treatment with inotrope at low dosage under continuously IABP support without a complications.

Dedicated nurse in collaboration with the physical therapist provide a self mobilization of the patient with ambulatory IABP that is favorable to strengthen the level of her autonomy during the pre-transplant period.

The out of bed position was performed by patient every day maintaining an acceptable level of muscle trophism to make the cardiac transplant program attainable.

The patient was ambulating during almost every day sessions of the physical therapy covering the distance about 260 meters. A comfort environment, a quality of sleeping  and  an unchanged  sleep-wake cycle are factors that enhance the patient’s experience.

After more than five months of hospitalization,  the patient receives her new heart.

Heart-failure associated cachexia and sarcopenia, one of the most critical issues in the patients with AHF  were regressed as a result of intensive physical activity and regular mobility of the patient.

Synergic effort and expertise of each member of the multidisciplinary team has been a significant impact to successfully bridges critically ill lady to her complete recovery after the heart transplantation.