title: Clinical psychological and neuropsychological issues with left ventricular assist devices (LVADs).
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) are increasingly being used to treat patients in end-stage heart failure (HF) as bridge-to-transplantation, lifetime support or destination therapy. However, the importance of this newer technique for chronic cardiac support compared to heart transplantation is still open to discussion. To date, there are few studies that extensively explore the psychological and cognitive profiles of patient with ventricular assist devices (VADs).
  
  
  METHODS
  We studied the psychological aspects, quality of life (QOL) and cognitive profiles of 19 patients with HF before VAD implantation and then at two, five and 16 months post-implantation.
  
  
  RESULTS
  Our results showed that after VAD implantation, patients did not show any psychopathological problems such as anxiety and/or depression. More interestingly, despite the constant risk of neurological events determined by the continuous-blood-flow pump (CBFP), patients' cognitive functioning did not worsen. In fact, significant enhancements were observed over time.
  
  
  CONCLUSIONS
  Psychological and cognitive deficits are common in advanced HF and often worsen over time. Appropriately designed and randomized studies are needed to demonstrate whether earlier VAD implantation is warranted to arrest cognitive decline and encourage better post-implantation adaptation.
authors.affiliation: 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Mapelli
authors.affiliation: 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Annachiara
authors.initials: A
authors.lastname: Cavazzana
authors.affiliation: 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cavalli
authors.affiliation: 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Tomaso
authors.initials: T
authors.lastname: Bottio
authors.affiliation: 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.affiliation: 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Bianca Rosa
authors.initials: BR
authors.lastname: Volpe
keywords: Left ventricular assist device (LVAD); cognitive functions; emotional profile; heart transplantation; quality of life (QOL)