Introduction
Regaining and restoring strength and vitality following extensive cardiac surgeries like heart transplantation warrant the success and prognosis of the surgery. Cardiac rehabilitation (CR) programs help the body to overcome stress and weakness evoked by the surgery. Cardiac rehabilitative interventions are designed to restore the patients to their normal life and enhance their quality of life. Various clinical trials prove the effectiveness of cardiac rehabilitative measures, so it is widely advised. It is not only for heart transplant patients but also for other patients with known cardiac diseases to reduce their possibility for cardiovascular events.
What Is Cardiac Rehabilitation?
Cardiac rehabilitation is a promising treatment strategy that aims to bring down various heart-related complications. It is an integrative and multifaceted approach that focuses on making the patient's life much easier and stress-free. It encompasses various forms of controlled exercise programs, dietary counseling, lifestyle modifications, and counseling sessions. Exercise and physical activities help the person enhance the power and energy of the heart, which when coupled with lifestyle and dietary modifications, aids in containing and restraining body weight. Counseling sessions make the patients aware of the importance of a healthy diet and mind to alleviate anxiety and emotional stress.
Cardiac rehabilitative programs are advised for all patients susceptible to developing heart disease or who already have an active cardiac ailment. In addition, it also helps patients who have undergone extensive and explorative heart surgeries, including heart transplantation. The program typically lasts six to 12 weeks, with inpatient and outpatient treatment modalities.
What Is Heart Transplantation?
Heart transplantation is a highly consequential surgical procedure in which the patient's defective and nonfunctional heart is substituted with a disease-free and functional human heart. The replanted heart is surgically moved from an organ donor's body, who might have suffered brain death ( permanent check on brain function where the person cannot sustain life without mechanical breathing support, with no scope for recovery).
Heart transplantation is often the final resort for grave cardiac conditions like end-stage heart failure (the heart is unsuccessful in driving out enough blood). Just like any other organ transplant, the donor's and recipient's blood and tissue cross-matching should be evaluated during heart transplantation. Only if it matches with that of the donor the transplantation is undertaken. Otherwise, the body would reject the newly placed heart, considering it an external organ. Not all heart patients are advised for heart transplantation. It is indicated for peculiar cases where other treatment modalities fail to precipitate fruitful results. The newly implanted heart will then take over the functions and restore uninterrupted blood flow to all cells in the body, keeping cellular vitality.
Utmost care should be employed during the transplantation process to ensure the success of the treatment. Various parameters and factors should be taken into account before advising a patient for heart transplantation, like the general health status (including the functional status of the other organs), estimated prognosis, patient's age, and underlying medical conditions, if any. The cardiac rehabilitation program re-establishes exercise tolerance and lung capacity, guaranteeing cardiorespiratory health.
What Is the Role of Cardiac Rehabilitation in Heart Transplantation?
Studies have concluded that cardiac rehabilitation programs drastically improved the survival rate of individuals with transplanted hearts. It appreciably brings down the risks of post-transplant complications and ill effects. However, strict adherence to rehabilitative strategies is essential to draw in the complete benefits of cardiac rehabilitation programs. In this program, the patients will be given clear instructions on dealing with stress.
Anxiety and unwanted stress create a burden on the heart and force it to work at a faster rate. In a heart transplant patient, the heart will take some time to adapt to the newly implanted body. If too much burden is loaded into it during the healing period, it can bring about various cardiac complications and even failure of the newly implanted heart.
It aids in checking the development of major adverse cardiac events (MACE) during and after the transplantation. Cardiac rehabilitation programs directly influence boosting immune status, physical strength, and mental well-being. Heart transplantation is a radical procedure that often creates mental trauma and undue concern about their life. These rehabilitative programs also focus on regaining physical and mental strength.
The pre-rehabilitation phase of cardiac rehabilitation for patients chosen for heart transplantation aids in preparing their body and mind for the surgery.
-
Phase I, initiated immediately after the transplantation when the patient is hospitalized, renders stability and strength.
-
Phase II and Phase III are outpatient programs that enhance the quality of their life and help them live a happy and healthy life.
What Are the Integrals in Cardiac Rehabilitation Programs That Are Specifically Designed for Heart Transplant Patients?
-
Risk Evaluation: The risk associated with each transplant patient will be evaluated and analyzed. It provides a clear idea about the possibility of rejection of the implanted organ. Educating the patients about the warning signs aids in the early identification of organ rejection so that immediate medical intervention can be adopted to safeguard the person's life.
-
Exercise Therapy: Exercise helps the body retrieve lost power and enhances breathing capacity, ensuring prompt oxygen delivery to the cells. In the initial days of post-transplantation, the patient should be made to do low-grade physical activity within the hospital setting, and later on, the nature of the exercise will be modified. It helps to re-establish lung and heart performance. The rehabilitative team will monitor the physical status and vital parameters during the exercise.
-
Dietary Control: Keeping track of the body weight and balancing it within the healthy range is of prime importance in heart transplant patients. An abrupt hike in body weight following a heart transplantation surgery exposes the patients to various post-transplant complications like cardiac allograft vasculopathy (transplant rejection), where heart rejection happens over a prolonged period. These conditions are often triggered by boosted blood sugar and cholesterol levels.
-
Pharmacological Therapy: Along with other non-pharmacological rehabilitative interventions, the patients must also follow medical therapy. Medications to check hyperlipidemia (boosted cholesterol level) and hypertension (hike in blood pressure) advised by the concerned doctor should be followed without fail. Cardiac rehabilitation programs emphasize the importance of proper medical therapy to clear off the risk factors, which can pave the way for post-transplantation complications.
-
Psychosocial Therapy: Another critical parameter of cardiac rehabilitation is psychosocial therapy, where the psychologists in the rehabilitative team help the patients to deal with emotional stress, sadness, depression, and anxiety. These conditions can overload the heart and can impact its function.
Conclusion
Heart transplantation is a critical surgery where the determinants of the treatment success lie partly on the patient's side through cardiac rehabilitation programs. These programs can significantly impact the treatment outcome in transplant patients. Transplant-related issues and concerns are often well attended to and tackled by cardiac rehabilitation programs, which are guided by a panel of specialist healthcare workers. Enrollment and retention in these programs are of great importance for transplant patients. It guides the patients from the preparatory phase to the recovery phase, while the patients have to keep a firm hold on all the advice and instructions given by the CR team throughout the rest of their life.
