Department of Cardiovascular Surgery Freiburg, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.
Eur J Cardiothorac Surg. 2012 Jun;41(6):1371-6; discussion 1376. doi: 10.1093/ejcts/ezr233. Epub 2012 Jan 4.
Previous studies indicate that patients with mechanical ventricular assist devices (VADs) experience high psychosocial and emotional distress. Listing for transplant may trigger psychosocial adjustment to the transplantation as an upcoming critical life-event. We hypothesized that patients could profit from this adaptation when implantation of a VAD becomes necessary.
We arbitrarily chose a cut-off at 30 days after being put on the heart transplantation (HTX) waiting list. Eighteen patients were listed for HTX for >30 days (referred to as 'listed') and 26 for shorter periods or not at all ('non-listed'). Survival, the occurrence of mental disorders, the number of contacts of the patient with the psychologist and times spent on psychotherapeutic support for both patient groups and for their families were analysed.
Survival after VAD implantation (observation time) and mental disorders were comparable for listed and non-listed patients. Mental disorders were developed in 80% of all patients irrespective of the listing group. The utilization of supportive psychotherapy did not differ between the listed and the non-listed group with regard to the number of contacts and to the time needed for individual therapy. Moreover, the number of families who requested support did not differ between the groups nor did the time spent on family therapy. However, the number of contacts and the time for individual psychotherapeutic support correlated with the observation time, whereas the time spent on family therapy did not. In contrast, family therapy correlated inversely with age. In addition, we compared bridge-to-transplantation patients with destination therapy patients. There were no differences in the occurrence of mental disorders, the number of contacts or in the time expenses for individual and for family therapy, neither for all patients nor after stratification for listing.
Our data indicate that listing for HTX for >30 days before VAD implantation does not reduce the utilization of psychotherapeutic support by VAD patients. We assume that structured emotional and psychosocial support by the interdisciplinary VAD team, including professional supportive psychotherapy, is indispensable for successful coping of VAD patients and their families.
先前的研究表明，患有机械心室辅助装置（VAD）的患者经历了较高的心理社会和情绪困扰。列入移植名单可能会引发对即将到来的关键生命事件——移植的心理社会调整。我们假设，当需要植入 VAD 时，患者可以从中受益。
我们随意选择了在被列入心脏移植（HTX）等待名单后的 30 天作为截止日期。18 名患者被列入 HTX 名单超过 30 天（称为“列入”），26 名患者列入名单的时间较短或根本未列入（“未列入”）。分析两组患者及其家属的生存情况、精神障碍的发生、患者与心理学家的接触次数和接受心理治疗支持的时间。
VAD 植入后的生存（观察时间）和精神障碍在列入和未列入名单的患者中是可比的。无论列入名单的组别如何，所有患者中有 80%都出现了精神障碍。列入和未列入名单的患者在接触次数和个体治疗所需时间方面，接受支持性心理治疗的情况没有差异。此外，请求支持的家庭数量在两组之间没有差异，家庭治疗所花费的时间也没有差异。然而，接触次数和个体心理治疗支持所需的时间与观察时间相关，而家庭治疗所花费的时间则不然。相比之下，家庭治疗与年龄呈反比。此外，我们比较了桥接移植和目的地治疗患者。在精神障碍的发生、接触次数或个体和家庭治疗所需的时间方面，两组患者均无差异，也没有分层列出的差异。
我们的数据表明，在植入 VAD 前列入 HTX 名单超过 30 天并不会减少 VAD 患者对心理治疗支持的利用。我们假设，由多学科 VAD 团队提供的结构化情感和心理社会支持，包括专业的支持性心理治疗，对于 VAD 患者及其家属成功应对是不可或缺的。
