Armenteros, T, Pietrafetta, K, Cohen, M; Jackson Memorial Hospital, Miami, FL and University of Miami, Miami, FL. taime@bellsouth.net.

The literature reports that approximately 100 patients have undergone heterotopic heart transplantation nationwide over the last 10 years. A review of the literature reveals minimal information on rehabilitation of a patient after this type of transplant. PURPOSE: The purpose of this study is to report on the rehabilitation process after heterotopic heart transplantation. Indications for heterotopic versus orthotopic transplant include donor type mismatch of the heart and/or elevated pulmonary artery pressures (PAP), which could lead to a heart-lung transplant or piggy-backing of a donor heart to the native heart. Piggy-backing of the heart presents a unique challenge to the physical therapist post-operatively for monitoring two hearts beating in one chest. SUBJECT: The subject was a 65 year old male who underwent heterotopic heart transplantation secondary to high pulmonary artery pressures at Jackson Memorial Hospital in Miami, FL, the first done at this facility. METHOD: This case study is a retrospective chart review. Data collected included a review of the physical therapy evaluation and assessments during his nine month pre-op phase, immediate post-op, including surgical intensive care, and rehabilitation phase. Other data collected included vital signs, dyspnea index, EKG, six minute walk tests, and diagnostic tests, such as echocardiogram, x-rays and cardiac catheterization. ANALYSIS: No statistical tools were used. RESULTS: The patient post-operatively had a clear physical exam with no significant post-op complications, and the post-transplant rehabilitation was routine for strength and endurance training. The unique challenge to the physical therapist for rehabilitation post-op was monitoring vital signs as the patient was on double telemetry, monitoring both the native and donor hearts. The main factors limiting participation in therapy were tachycardia and anxiety-induced dyspnea, the latter treated with breathing/relaxation exercises and anti-anxiety medication. Depression was also a factor pre- and post-operatively, affecting motivation for therapy. CONCLUSION: Except for double telemetry monitoring, cardiac rehabilitation of the patient who underwent heterotopic heart transplantation was similar to the patient with orthotopic transplantation. Anxiety and depression are often seen in patients listed for transplant and are treated as indicated before and after surgery. Physical therapists treating patients after a heterotopic heart transplant should be skilled and experienced in treating high risk cardiac patients. FUNDING SOURCE: None.

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