The Journal of Thoracic and Cardiovascular Surgery
Adult: Mechanical Circulatory SupportValue of psychosocial evaluation for left ventricular assist device candidates
Graphical abstract
Section snippets
Population
From April 1, 2013, to January 1, 2019, 374 patients underwent primary durable LVAD implant. We excluded patients aged less than 18 years (N = 21), patients who did not have a SIPAT assessment before LVAD (N = 51, Figure E1), patients with a total artificial heart (N = 1), patients requiring temporary or durable biventricular support (N = 24), and patients undergoing device exchange (N = 14). Our final cohort consisted of 263 patients (Figure E2). The study was approved by the Cleveland Clinic
Baseline Characteristics
Our cohort consisted of 263 patients with LVADs (46% bridge to transplantation, 54% destination therapy) with 100 (38%) Heartware devices (Medtronic, Minneapolis, Minn), 80 (30%) HeartMate 2 devices (Medtronic), and 83 (32%) HeartMate 3 devices (Medtronic) followed for a median of 1.2 years (Table 1). The mean age of patients was 58 years, with the majority white, married men. Most patients had a dilated nonischemic cardiomyopathy and were Interagency Registry for Mechanically Assisted
Discussion
Durable mechanical circulatory support implantation remains one of the few cardiac operations that requires a psychosocial evaluation1 despite limited data predicting any adverse outcome.2 This requirement is based on the complexity of lifelong LVAD management and need to determine transplant candidacy. SIPAT is commonly used for psychosocial evaluations by LVAD programs since validated to predict transplant outcome8 but has not been validated to predict outcome after LVAD implants. On the
Conclusions
SIPAT is a useful psychometric tool to evaluate patients with advanced heart failure and efficient because the same test known to predict outcome in transplant has now been shown to predict LVAD outcomes. Although the total SIPAT score was not associated with readmission or mortality, SIPAT domains were associated with LVAD outcome. For instance, patient readiness was associated with noncardiac and cardiac readmissions, social support was associated with device-related readmissions, and
References (25)
- 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) - et al.
Ventricular assist devices: a review of psychosocial risk factors and their impact on outcomes
J Card Fail
(2014) - et al.
Psychosocial characteristics and outcomes in patients with left ventricular assist device implanted as destination therapy
Am Heart J
(2015) - et al.
Caregiver status and outcomes after durable left ventricular assist device implantation
Heart Lung
(2017) - et al.
Assessment of pre-operative psychosocial function among people receiving left ventricular assist devices: a national survey of US LVAD programs
Heart Lung
(2019) - et al.
The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates
Psychosomatics
(2012) - et al.
Identifying risk factors: challenges of separating signal from noise
J Thorac Cardiovasc Surv
(2017) - et al.
Marital status improves survival after orthotopic heart transplantation
J Heart Lung Transplant
(2011) - et al.
Impact of primary caregivers on long-term outcomes after lung transplantation
J Heart Lung Transplant
(2015) - et al.
The Society of Thoracic Surgeons Intermacs 2019 annual report: the changing landscape of devices and indications
Ann Thorac Surg
(2020)
Cited by (3)
Commentary: Bringing objectivity to the nonmedical evaluation of left ventricular assist device candidates
2023, Journal of Thoracic and Cardiovascular SurgeryCommentary: How to predict a harmonious relationship between patients and their left ventricular assist device?
2023, Journal of Thoracic and Cardiovascular SurgeryCommentary: In search of the “good candidate” for mechanical circulatory support
2023, Journal of Thoracic and Cardiovascular Surgery
Informed Consent: Cleveland Clinic Institutional Review Board (IRB) number 15-643, approved May 13, 2019 (5/21/2019-5/20/20) and renewed May 15, 2020 (5/21/2020-5/20/2021). Date and number of IRB approval: Approved June 17, 2019, IRB #15-643.
Supported by Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic. Dr Hsich is supported by the National Heart, Lung, and Blood Institute of the National Institute of Health under Award Number HL141892.
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Additional SIPAT Research Group collaborators: Shinya Unai, MD, Terrence Roncagli, LISW-S, Alexandra C. W. Sakai, MSW, LISW-S, from the Cleveland Clinic Heart and Vascular Institute, Transplant Center.