Gamified Cardiopulmonary Rehabilitation in a Child Undergoing LVAD Bridging Therapy to Heart Transplantation: A Case Report

This report details the comprehensive, gamified cardiopulmonary rehabilitation of a 6-year-old girl undergoing a complex clinical journey from left ventricular assist device (LVAD) bridge therapy to successful heart transplantation. Given the paucity of standardised protocols for this high-risk population, a structured, multidisciplinary team (MDT)-guided pathway was implemented, adapting interventions to the distinct phases of LVAD support and post-transplant recovery. Key nursing and rehabilitation strategies included initiating very early mobilisation in the cardiac intensive care unit (CICU) with meticulous safety precautions for the LVAD driveline and post-sternotomy incision, implementing a tiered programme of play-based respiratory training games to improve pulmonary function, and guiding the patient through a progressive, gamified exercise regimen encompassing low-intensity aerobic games and combined resistance-aerobic training. Throughout, continuous risk monitoring and dynamic adjustment based on haemodynamic and device-specific parameters were paramount. This individualised, phased approach effectively improved the patient's cardiopulmonary function, muscle strength and exercise tolerance. She was discharged on postoperative Day 44 with a left ventricular ejection fraction of 69%, NYHA Class I cardiac function, grade 5 muscle strength and a 6-min walk distance of 260 m, without rehabilitation-related adverse events. This case demonstrates a feasible and effective model for rehabilitating paediatric patients across the challenging continuum from mechanical circulatory support to heart transplantation. This case provides a structured, reproducible framework for cardiopulmonary rehabilitation in paediatric patients transitioning from LVAD support to heart transplantation. It emphasises the necessity of phase-adapted interventions, rigorous safety monitoring and the integration of gamification to enhance engagement and outcomes, offering practical guidance for nurses and therapists in this specialised field.