A multicomponent cardiac rehabilitation programme as a safe, feasible, and beneficial approach, including patients with left ventricular assist devices: a case report

Abstract Background Left ventricular assist devices (LVADs) are a well-established therapy for advanced heart failure (HF) used either as a bridge-to-transplant or destination therapy. While cardiac rehabilitation programmes (CRPs) are guideline-recommended in other HF stages, specific data on their role in LVAD recipients remains limited. We present a case of tailored CRP in a LVAD-supported patient highlighting the importance of understanding the device’s intrinsic limitations to ensure safe and effective exercise prescription. Case summary A 56-year-old man with cardiovascular risk factors presented with anterior ST-elevation myocardial infarction developing severe left ventricular dysfunction, INTERMACS III, and recurrent ventricular arrhythmias, leading to HeartMate 3 (HM3) LVAD implantation as a bridge-to-transplant. Persistent smoking led to discontinuation of prehabilitation and removal from the transplant waitlist. A destination therapy strategy was considered and referred to the CRP. Baseline and final assessments included a CPET-ESE, clinical-functional evaluation, and PROMs. The rehabilitation physician, as part of the multidisciplinary team, adapted the exercise prescription to manage neuropathic pain due to a suspected spinal cord injury. Doppler-MAP and HM3 LVAD parameters were monitored before and after each session. The patient completed a tailored 12-week CRP with high adherence and no major adverse events. Improvements were observed in submaximal CPET parameters: VO₂ at VT1, OUES and VE/VCO₂ slope, right ventricle contractility, muscular efficiency, and QoL. Persistent smoking remained the main management challenge. Discussion Tailored CRP with careful haemodynamic monitoring is safe, feasible, and effective in patients with HM3 LVAD. A multidisciplinary approach is essential to optimize functional outcomes and long-term prognosis.