Physical Therapy Across the Care Continuum for a Patient Post-LVAD With Right Ventricular Failure and Critical Illness Polyneuropathy

Purpose: Orthotopic heart transplant (OHT) and left ventricular assist devices (LVADs) are key treatments for advanced heart failure, with LVADs increasingly used as bridge to transplant (BTT). However, complications like right ventricular (RV) failure can hinder recovery, prolong hospitalization, and limit functional gains needed for OHT candidacy. This case describes physical therapy's role in optimizing function post-LVAD implantation complicated by RV failure and suspected CIP. Methods: A 53-year-old woman with viral cardiomyopathy and biventricular heart failure underwent HeartMate III LVAD implantation as a BTT candidate. Postoperatively, RV failure required 26 days of right ventricular assist device (RVAD) support, and suspected critical illness polyneuropathy led to profound weakness as measured by a score of 8/24 on the Activity Measure for Post-Acute Care Basic Mobility Inpatient Short Form (AM-PAC). Results: After 34 intensive care unit (ICU) PT sessions, she improved (AM-PAC 11/24) before progressing through the step-down unit and acute inpatient rehab (AIR). At AIR discharge, she ambulated 12 feet (AM-PAC 17/24). Outpatient Physical Therapy (PT) was hindered by medical setbacks, underdosed interventions, and insurance restrictions, leading to functional decline. After targeted therapy in a pro-bono PT clinic, she improved gait distance to 56 feet. However, she failed to meet transplant criteria before worsening RV failure and transitioned to hospice. Conclusions: This case highlights physical therapy's role in optimizing functional independence and transplant candidacy post-LVAD implantation. Although early rehabilitation improved mobility, outpatient progress was hindered by underdosed interventions, insurance restrictions, and a lack of LVAD-specific rehabilitation expertise, contributing to functional decline. The case underscores the need for standardized outpatient rehabilitation, greater clinician education on LVAD management, and improved access to specialized therapy to enhance outcomes.