Grogan Sherry, Kostick Kristin, Delgado Estevan, Bruce Courtenay R
Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
Baylor College of Medicine, Houston, Texas.
Methodist Debakey Cardiovasc J. 2015 Jan-Mar;11(1):9-11. doi: 10.14797/mdcj-11-1-9.
One of the candidate evaluation challenges is determining when and how psychosocial domains influence short- and long-term destination therapy ventricular assist device (DT-VAD) outcomes. There are very few DT-VAD studies and no validated instruments to identify psychosocial risk factors. General practice is to borrow from the transplant literature, which may not be applicable to this unique device application. We question the relevance of using transplant psychosocial evaluation for patients who are candidates for DT-VAD only, particularly because these patients require a certain level of cognitive, psychological, and behavioral functioning to ensure proper long-term self-care with the VAD. We may be missing important psychological characteristics in our pre-evaluations by "borrowing" from the transplant literature, thereby underplaying significant factors that are especially relevant for DT-VAD candidates. Conversely, we may be screening out candidates who may benefit greatly from DT-VAD by using transplant criteria as part of the screening process. We use a case study to illustrate some of the challenges of weighing psychosocial risk factors in the DT-VAD population and to emphasize the need for developing distinct psychosocial assessment criteria for DT-VAD patients.
候选者评估面临的挑战之一是确定心理社会领域在何时以及如何影响短期和长期目标治疗心室辅助装置（DT-VAD）的治疗效果。DT-VAD研究非常少，且没有经过验证的工具来识别心理社会风险因素。一般做法是借鉴移植领域的文献，但这可能不适用于这种独特的装置应用。我们质疑仅将移植心理社会评估用于DT-VAD候选患者的相关性，特别是因为这些患者需要一定水平的认知、心理和行为功能，以确保使用VAD进行适当的长期自我护理。通过从移植文献中“借鉴”，我们可能在预评估中遗漏重要的心理特征，从而低估了对DT-VAD候选者尤为相关的重要因素。相反，我们可能会通过将移植标准作为筛查过程的一部分，筛掉可能从DT-VAD中获益匪浅的候选者。我们通过一个案例研究来说明在DT-VAD人群中权衡心理社会风险因素的一些挑战，并强调为DT-VAD患者制定独特的心理社会评估标准的必要性。
