Early Mobilization Following Heart Transplantation

The prognosis of heart transplantations has considerably improved yet in the last 10 to 20 years. Despite the considerable progress made in the fields of operative techniques and pharmacology, physiotherapy still remains an essential part of the pre- and postoperative treatment programme. Before the heart transplantation, kinesiotherapy is used to maintain the normal body weight through muscular exercise and to train the respiratory function in order to minimize postoperative risks, one of the main objectives is to teach respiratory and tussive techniques which produce low intra-thoracic pressures. During the postoperative per,bd, the physician and the therapist have to bear in mind that the patients tend To show a delayed increase of the heart frequency but more strongly influenced by physical effort as well as a tower maximal pulse rate (approx. 135 heart beats per minute) and a more slowly decreasing pulse rate after the effort These changed conditions regarding the heart-circulation have absolutely to be taken into account and the physiotherapeutical exercise programme adapted correspondingly, and particularly so during the period of intensive care. As far as the postoperative respiratory therapy is concerned, the physiotherapeutical measures used should correspond to the patient's needs and comprise the following: acquisition of new techniques allowing the use of supplementary "breathing space" (e.g. costoabdominal, costosternal inverse respiration), tapotement manual vibratory massage and exercising tussive techniques.