title: Mental health status of patients with mechanical aortic valves, with ventricular assist devices and after heart transplantation.
abstract: Mental health is a complex construct, in which emotional aspects and quality of life are central. It has been assessed in patients after heart transplantation (HTX) and occasionally in those with ventricular assist devices (VADs). However, there are no studies that compare patients with primary HTX with those with HTX ending VAD support. Evidence for patients with mechanical aortic valve replacement is also limited. We compared mental outcome for these four groups for the first time. We also focused on the question of an artificial device, i.e. VAD or mechanical aortic valve, as distinct from a biological graft, i.e. HTX.
  
  
  
  Two questionnaires were applied: The Hospital Anxiety and Depression Scale, the German version consists of two subscales for anxiety and for depression, and the 12-item Short Form Health Survey, the German version contains two subscales for physical and for mental performance measuring quality of life. We included 46 patients with mechanical aortic valve replacement, 55 after HTX and 22 on support by a long-term VAD. The HTX group consisted of 38 patients with primary HTX and 17 recipients who were on VAD support before transplantation. The index operation was at least 6 months ago.
  
  
  
  HTX patients suffered less from anxiety and depression than patients with mechanical aortic valve replacement or those on VAD. HTX patients had higher scores on the physical scale but not on the mental component scale of the 12-item Short Form Health Survey compared with VAD patients. Conversely, patients with mechanical aortic valve replacement did worse with regard to mental but not physical performance compared with HTX patients. VAD and mechanical aortic valve replacement patients differed only with regard to physical condition, but not with regard to anxiety, depression and mental status. HTX patients with and without VAD support before transplantation achieved similar values on all scales. Mental scales did not correlate with age or time after surgery.
  
  
  
  HTX patients had the best outcome compared with the other groups with respect to mental health. Mechanical aortic valve replacement patients did not differ from VAD patients with respect to anxiety, depression and mental quality of life scores. Mechanical aortic valve replacement patients might be more in need of psychological support than expected. Further, VAD patients who undergo HTX reach similar mental and physical results when compared with patients with primary HTX, i.e. they seem to cope well in the long run.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Heilmann
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Josefine
authors.initials: J
authors.lastname: Kaps
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Zeh
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany.
authors.forename: Anna Lena
authors.initials: AL
authors.lastname: Anjarwalla
authors.affiliation: Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.affiliation: Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Siepe
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany andreas.joos@uniklinik-freiburg.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Joos
mesh_terms: D001007:Anxiety / Q000523:psychology*; D001021:Aortic Valve / Q000601:surgery; D003863:Depression / Q000523:psychology*; D005260:Female; D016027:Heart Transplantation; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Anxiety; Aortic valve replacement; Heart transplantation; Mental health; Ventricular assist device