Quality of Life and Mental Recovery after Left Ventricular Assist Device Implantation Compared to Heart Transplantation

Background: Due to the shortage of organ donors the number of continuous flow left ventricular assist device (cfLVAD) implantation is increasing. The aim of this study was to compare early quality of life (QoL) and mental recovery of patients with cfLVAD compared with patients after heart transplantation (HTx).

Methods: In this study we included all adult patients who either received a cfLVAD (n = 5) with a preoperative INTERMACS level of 3, or a HTx (n = 7) in our center in the time from February to June 2017. QoL was assessed using the SF-36 and the mental state assessing e.g., depression and anxiety using the HADS questionnaire (a depression score of ≤7 and an anxiety score ≤7, in total ≤14 means normal mental state). Data were collected 25 ± 10 days preoperatively and 1, 3 and 6 months postoperatively. Statistical analyses were performed using SPSS Statistics version 24 using t-test, chi-square test, and Cox-regression for survival.

Results: Mean age was 52 years (±11 years), 69% patients were male, and overall survey completion was 92%, with an overall survival of 91% (one patient of the LVAD group died after 5 months after implantation due to respiratory failure, survival in HTx group was 100%). In the LVAD-group patients had a worse preoperative condition regarding mental health, depression and anxiety with a score of 19 (±10) compared with the HTx-group with a score of 10.6 (±4.8). Preoperative QoL was in the LVAD-group 320,69 (±186) compared with 340 (±89) in the Tx-group. At 3 months after VAD implant overall QoL improvement was 71points (up to 391.37 (±186.2)) compared with 100points in the HTx-group (up to 472.4 (±131.7)). Depression and anxiety dropped down in the HTx-group from 4.8 (±1.8) to 3.8 (±3.1) and 5.8 (±3.5) to 4.4 (±3.3) and in the LVAD-group anxiety was reduced from 8.2 (±4) to 3 (±2.6) and depression score from 10.7 (±6) to 7 (±3).

Conclusion: In our study we were able to show that after 6 months QoL increased and the mental state recovered after cfLVAD implantation but both QoL and mental state were still less compared with patients after HTx. Consequently, cfLVAD patients could benefit from a psychological support to improve especially the mental state before and after cfLVAD implantation.