左心室辅助装置（LVAD）的临床心理和神经心理学问题。
Clinical psychological and neuropsychological issues with left ventricular assist devices (LVADs).
机构信息
1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
出版信息
Ann Cardiothorac Surg. 2014 Sep;3(5):480-9. doi: 10.3978/j.issn.2225-319X.2014.08.14.
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.
背景
左心室辅助装置（LVADs）越来越多地被用于治疗终末期心力衰竭（HF）患者，作为桥接移植、终身支持或目的地治疗。然而，与心脏移植相比，这种治疗慢性心脏支持的新技术的重要性仍存在争议。迄今为止，很少有研究广泛探讨心室辅助装置（VADs）患者的心理和认知特征。
方法
我们研究了 19 例 HF 患者在 VAD 植入前和植入后 2、5 和 16 个月的心理、生活质量（QOL）和认知特征。
结果
我们的研究结果表明，VAD 植入后，患者没有表现出任何精神病理问题，如焦虑和/或抑郁。更有趣的是，尽管连续血流泵（CBFP）不断带来神经事件的风险，但患者的认知功能并没有恶化。事实上，随着时间的推移，认知功能有了显著的提高。
结论
心理和认知缺陷在晚期 HF 中很常见，而且随着时间的推移往往会恶化。需要进行设计合理、随机的研究，以证明是否需要更早地进行 VAD 植入以阻止认知能力下降并鼓励更好的植入后适应。
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