Mechanical circulatory support as a bridge to heart transplantation: what remains? Long-term emotional sequelae in patients and spouses.
BACKGROUND
Implantation of a ventricular assist device (VAD) reduces short-term mortality and morbidity and provides patients with reasonable quality of life even though it may also be a long-lasting emotional burden. This study was conducted to analyze the long-time emotional consequences of VAD implantation, followed by heart transplantation in patients and spouses.


METHODS
This cross-sectional study used the Impact of Event Scale-Revised (IES-R) Version, recording avoidance, intrusion, and hyperarousal, to investigate symptoms of post-traumatic stress disorder (PTSD), and VAD-related fears and concerns. The study cohort comprised 38 patients (36 men, 2 women) and 27 spouses (26 women, 1 man), 6 to 135 months post-operatively.


RESULTS
Seven (26%) of the 27 spouses but none of the patients met the criteria for PTSD. Patients who were operated at the early stage of our VAD program (82.0 +/- 31.4 months between implantation and evaluation) were significantly more likely to have a spouse with PTSD syndromes than those whose operation took place later on (42.1 +/- 31.1 months, p = 0.007). Patients with higher avoidance scores and a higher level of hyperarousal were significantly more often affiliated with a PTSD spouse than those with lower avoidance (p = 0.008) and hyperarousal scores (p = 0.001). Spouses displayed significantly higher scores in all IES-R dimensions, and they worried more about device-related problems (malfunctioning, pain, infection, and stroke) than the patients themselves. The noise of the device system was not a crucial issue.


CONCLUSIONS
Our study found that implantation of a VAD, followed by transplantation, does not lead to PTSD in patients but it does in their spouses in the long run. Their emotional well being deserves much closer attention.
Bunzel
Brigitta
B
Department of Cardiothoracic Surgery, Medical University of Vienna, Austria. brigitta.bunzel@meduniwien.ac.at
Laederach-Hofmann
Kurt
K
Wieselthaler
Georg
G
Roethy
Wilfried
W
Wolner
Ernst
E
D000342:Affective Symptoms / Q000209:etiology*; D001143:Arousal; D001362:Avoidance Learning; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004834:Epilepsy, Post-Traumatic / Q000209:etiology / Q000523:psychology; D005239:Fear; D005260:Female; D016027:Heart Transplantation / Q000523:psychology*; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D008297:Male; D010361:Patients / Q000523:psychology*; D011788:Quality of Life; D012189:Retrospective Studies; D018454:Spouses / Q000523:psychology*; D013997:Time Factors