Disclosures: Neha K. Aggarwal, MD: Nothing to disclose

Case Description: A 24-year-old male with history of DMD-induced cardiomyopathy was admitted after being found as an outpatient to have ejection fraction of 20%. His cardiac output was refractory to all temporizing measures including balloon pump and Impella. He was therefore determined to be a candidate for permanent LVAD implantation.

Setting: Acute Inpatient Rehabilitation Hospital

Patient: 24-year-old male with cardiomyopathy from Duchenne Muscular Dystrophy requiring LVAD implantation.

Assessment/Results: The patient was subsequently admitted into an acute multidisciplinary inpatient rehabilitation program. He had previously been functionally independent, and after hospitalization, required maximal assistance for all activities of daily living. Thus far, he has undergone 1 month of intensive rehabilitation with cardiac and musculoskeletal monitoring given his underling DMD. Outcome scores measured after approximately 4 hours of therapy per day demonstrate modified-independent level for activities of daily living. The patient has made great progress and is now able to ambulate over 150 feet with a standard rolling walker, approximately 2 months after LVAD implantation. He is currently still in acute rehabilitation and making daily gains. This case shows that DMD patients with LVAD can have remarkable recovery in acute rehabilitation, but they do require a prolonged rehabilitation course in order to succeed.

Discussion: There is currently a paucity of literature describing LVAD in patients with end stage dystrophinopathies. There is currently no literature to date that describes the functional outcomes of these patients after LVAD implantation. This patient’s significant functional improvement after intensive inpatient rehabilitation demonstrates the utility of a comprehensive rehabilitation program in this particular subset of patients.

Conclusion: Though dystrophinopathy-induced heart failure is a terminal diagnosis, evidence demonstrates that LVAD placement will improve their mortality. It stands to reason, then, that placing these patients in a targeted, acute inpatient rehabilitation program will allow maximal functional outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/intensive-rehabilitation-of-dystrophinopathy-induced-heart-failure-after-lvad-implantation-a-case-report/