A Progressive Mobilization Protocol for Surgically Implanted Temporary Ventricular Assist Devices: A Retrospective Cohort Study

Axillary percutaneous ventricular assist devices (pVADs) are increasingly utilized for refractory cardiogenic shock, yet standardized mobilization protocols are lacking. This study describes a structured mobilization protocol and evaluates its implementation in 196 patients supported with an axillary pVAD from December 2020 to June 2025. Of this cohort, 131 (67%) were mobilized per a progressive multidisciplinary exercise protocol. Mobilized patients achieved significantly higher functional status by intensive care unit (ICU) discharge via Johns-Hopkins Highest Level of Mobility (JH-HLM) scoring (p < 0.001) and hospital discharge (p = 0.002). Longitudinal analysis demonstrated significant stepwise improvement in JH-HLM scores across sessions (p < 0.001) with statistical gains appearing as early as the third session (p < 0.001). Stratified analysis confirmed feasibility across all clinical outcomes, including recovery (p = 0.002), durable left ventricular assist device (LVAD) (p < 0.001), and heart transplant (p = 0.023). Regarding clinical outcomes, the mobilized cohort had a lower mortality rate (12% vs. 58%), higher rates of myocardial recovery (46% vs. 25%), durable LVAD implantation (21% vs. 9%), and heart transplantation (20% vs. 8%) (p < 0.001). This technical report details a safe, reproducible framework for patients with axillary pVAD support, showing that a structured mobilization protocol is feasible and associated with progressive improvement in functional status.