Ventricular assist devices (VADs) can provide heart failure (HF) patients improved quality of life, physical function, and prolonged survival (Rose 2001, Kormos 2019). Over the past two decades, the number of VAD recipients has rapidly grown; the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) reports an increase in VAD implantations from 2,156 between 2006–2010, to 10,174 between 2013–Sept 2017. Furthermore, the 5-year survival rate post-VAD implantation is increasing, and patients are increasingly likely to receive VADs as a destination therapy, as opposed to a bridge to heart transplant (Kormos 2019, INTERMACS 2017). As a result, consultation-liaison psychiatrists and psychologists are increasingly likely to care for VAD recipients, and their input may be sought for pre-VAD evaluation of HF patients. However, while psychiatric co-morbidities associated with HF are well established (Rutledge 2006), their impact on VAD recipients is less well understood, and there are significant knowledge gaps in the management of these patients (Dew 2018). This symposium will provide an overview of VAD therapies, recommended approaches to the pre-VAD evaluation, and key considerations when treating patients with VADs, in order to improve our ability to care for this population.
In this symposium sponsored by the transplant and cardiology SIGs, we will focus on current gaps in our knowledge regarding management of VAD recipients. In particular, Dr. Dew will first discuss the most recent society-based recommendations for psychosocial assessment of VAD candidates, how they were developed, and controversial issues addressed during their development. Dr. Suarez will discuss mood symptoms including depression in this population. Dr. Nash will discuss acute pain management, and the role of psychiatric co-morbidities on post-VAD implantation pain severity. Dr. Caro will discuss the role of cognitive impairment in this population.
Following the 4 speakers, there will be time reserved for questions and discussion, moderated by Dr. Ben Lee.
Dew MA, et al. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. J Heart Lung Transplant. 2018;37(7):803-23.
Interagency Registry for Mechanically Assisted Circulatory Support Quarterly Statistical Report. The Data and Clinical Coordinating Center: University of Alabama at Birmingham, 2017 12/18/2017. Report No. #HHSN268201100025C.
Kormos RL, et al. The Society of Thoracic Surgeons INTERMACS database annual report: Evolving indications, outcomes, and scientific partnerships. J Heart Lung Transplant. 2019;38(2):114-26.
Rose EA, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435-43.
Rutledge T, et al. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48(8):1527-37.