Rehabilitation of patients with terminal heart failure by heart transplantation: a view from an expert physician

Background. The presence of persistent dysfunctions of the body of moderate, severe and significantly severe degrees after a heart transplant, as well as limitations in life activities, is the basis for referring the patient for a medical and social examination. Objective. To study the clinical, functional and expert parameters of patients after orthotopic heart transplantation referred to the bureau of medical and social examination. Materials and methods. A retrospective analysis of “Referrals for medical and social examination by a medical organization” (form N088/u) and “Acts of medical and social examination” was performed in 40 patients referred for medical and social examination. 12 (30 %) patients were examined initially, 28 (70 %) were re-examined. Results. In the late postoperative period, chronic heart failure stage I was diagnosed in 25 patients (73.5 %), stage II A — in 6 (17.6 %), stage II B — in 2 (5.8 %), and stage III — in 1 (3.1 %) person. Severe paroxysmal heart rhythm disturbances were detected in 15 patients (37.5 %). In 7 patients (17.5 %), hemodynamically significant stenosis of the coronary arteries was determined after heart transplantation. Before the operation, the left ventricular ejection fraction was significantly reduced in all patients (mean value — 25 %), after the operation, in most cases, an increase in myocardial contractility was noted (mean value of the ejection fraction — 65 %), which confirmed satisfactory function of the transplant. The degree of graft rejection was 0−1R, according to the results of histological examination. During the initial examination at the Bureau of Medical and Social Expertise, all patients were found to have persistent disorders of the blood and immune systems of the IV degree, and during the repeated examination, cardiovascular system disorders of the II−IV degrees, as well as limitations of life activities of the 1−3 degrees. According to current regulatory documents, all initially examined patients after heart transplantation, due to significant impairments of the blood and immune systems and limitations of the main categories of life activities, have been assigned Group I disability for 2 years. During the repeated examination after 2 years of observation, moderate cardiovascular dysfunctions (quantitative assessment 40−60 %) and limitations of life activity 1st degree were detected in 25 (89.2 %) patients, they were recognized as disabled persons of group III. Severe dysfunctions of the body (quantitative assessment 70−80 %) and limitations of life activity 2 degrees were observed in 2 patients (7.1 %), who were recognized as disabled persons of group II. Significantly pronounced dysfunctions of the cardiovascular system and limitations of life activity 3 degrees were determined in one patient (3.7 %) (quantitative assessment 90−100 %), who was assigned to group I disability. Conclusion. Heart transplantation is an effective method of treating patients with terminal chronic heart failure, however, in some cases, complete rehabilitation of patients cannot be achieved due to deterioration of the function of the cardiac transplant.