Rehabilitation early after Heart Transplantation: Modalities and Feasibility Meurin 1, JY. Tabet 1, S. Varnous 2, C. Aubailly 2, F. Gabin 3, H. Weber 1, S. Ouldamar 2, S. Guendouz 3, A. Ben Driss 1,C Ly 1 N,A Grosdemouge 1,R Dumaine 1,N Renaud 1 (1) Les Grands Prés, Villeneuve Saint Denis, France (2) University Hospital Pitié-Salpêtrière, Paris, France (3) University Hospital Henri Mondor, Hospital Mondor, Creteil, France Background and objectives Methods (1) ResultsAbstract Conclusion During the three first months following heart transplantation, 1-Many complications can occur 2- But a prolonged in-hospital stay is expensive and not medically justified by the general condition of the patients. 3-Exercise training is mandatory Can an in-patients Cardiac Rehabilitation Center (in-CRC) fulfill the two following objectives?: 1 - safely treat sub acute complications at a lesser cost than a classical hospital, -under the guidance of the referent organ transplantation center (Ref-OTC) 2 - Perform an exercise training program. -Exercise Capacity Improvement evaluated only in Group 1 ( > 5 Exercise Training Sessions ) Retrospective Monocentric Study inclusion Criteria: -100 consecutive patients directly referred to our in-CRC center (without home return between surgery and in-CRC hospitalization) less than 3 months after cardiac transplantation -Cost comparison with 500 consecutive non transplanted patients Exercise Training Sessions: -3-5 sessions per week, including Bicycle exercise training: min Callisthenic: 45 min Patients separated in 2 Groups -Group 1: Patients effectively Trained: > 5 Exercise Training sessions -Group 2: Patients not effectively Trained (whatever the reason): ≤ 5 sessions Severe Infection (n=11) -Mediastinitis (5) -Pleural abcess (2) -Angiocholitis (1) -Severe renal infection (1) -Sinusitis requiring surgery (1) -Aspergillus pneumonia (1) Severe Cardiac Graft Rejection (3) Cardiac conduction disorder (2) Tamponade (1) Others (5) Ref-Organ Transplantation Center Readmission [n = 22 (22 %)] Motives Exercise Capacity Improvement Heart Rate evolution Exercise tests Group 1 Evolution [n = 77 (77%),13±5 Training Sessions] Additional costs for the CRC Comparison transplanted versus non transplanted (n=500 consecutive patients) Background: During the three first months following heart transplantation, patients still require close medical follow up and exercise training (because of major pre and post operative muscular wasting). The objective of the study was to assess the usefulness of an inpatients Cardiac Rehabilitation center (inCRC) in these two settings. Methods: 100 consecutive patients (age:47.2 ± 13.2, men: 79%) referred to our inCRC less than 3 months after heart transplantation were included. Acute events (AE) occurring during the inCRC stay, exercise training modality and results were assessed. Results :Patients were hospitalized in the inCRC 33.8 ± 21.3 days after the transplantation, for a 25.9 ± 11.2 days duration on average. During this period, AE occurred in 49% (n=49) of the patients: 24 graft rejection, 19 bacterial or fungal infection requiring IV antibiotherapy, and 6 other AE. Most of these events were managed by the inCRC but 22 patients were temporarily referred to the transplantation center because of too severe AE (infection: n = 11, tamponade: n = 1, acute rejection requiring plasmapheresis: n = 3, other: n=7).17 patients (17%) were colonized by a multiresistant bacterium which required contact precautions during the exercise training sessions. Moreover, patients underwent 2.8 ± 1.4 endomyocardial biopsies. Finally, due to all these event,23%(n=23) of the patients underwent only 5 exercise training sessions or less. The exercise capacity improvement after completion of a classical exercise training program (n = 13 ± 5 sessions) is given in the table below for For the 77 other patients (77%). Conclusion : Early after heart transplantation an inCRC can be useful (i) to-at a lesser cost than in a classical hospital- safely treat subacute complications under the guidance of the referent transplantation center and (ii) to perform an exercise training program. Early after Heart Transplant, Cardiac Rehab is very important: -To Treat Subacute Complications -To Guide Efficient Exercise Training Sessions This Strategy is highly cost-effective for Healthcare System : -26 days In-CRC at a price per day of 265 € :cost per stay= 6890 € -versus € if the patient had been hospitalized in the Ref-OTC But Additional Costs for Cardiac Rehab center is High -The Price Per Day paid by Social Security System to in-CRC is the same for transplanted and non transplanted patients while the additional cost for transplanted patients is 32% higher Methods (2) Results Baseline Characteristics of the Patients Intra Cardiac Rehabilitation Center Evolution Costs comparison: Transplanted n=100) versus 500 consecutiven non transplanted (heart failure, post cardia surgery and post myocardial infarction) patients)

During the three first months following heart transplantation, – 1-Many complications can occur – 2- But a prolonged in-hospital stay is expensive and not medically justified by the general condition of the patients. – 3-Exercise training is mandatory

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