Diaphragm Training in Patients With Left Ventricular Assist Devices: A Narrative Review of Rehabilitation and Clinical Implications

Chronic heart failure (HF) is a syndrome that affects millions of people globally each year. If a patient with HF does not respond to standard therapy (pharmacological and/or instrumental), the gold standard treatment for end-stage HF is heart transplantation (HTx). The increasing number of end-stage HF patients does not correspond to the number of available HTx procedures. To address this discrepancy and attempt to prolong life, another therapeutic option is the implantation of durable left ventricular assist devices (LVADs), with the next-generation HeartMate 3 device (HM3; Chicago, IL: Abbott). As with HF, LVAD patients can safely access a cardiac rehabilitation (CR) program, with various clinical benefits and improved quality of life. What emerges from the literature is the near-absence of guidance on diaphragm rehabilitation, despite the pathophysiological adaptations this muscle undergoes. This review aimed to emphasize the importance of routinely incorporating inspiratory muscle training (IMT) into the CR process. The article will also briefly review the history of LVADs, with a focus on newer generations of devices, including how the device works, the adverse events that occur, and the positive clinical adaptations observed with CR.