What the Psychiatrist Needs to Know About Ventricular Assist Devices: A Comprehensive Review

• Published in: Psychosomatics (Washington, D.C.) D.C.), 2016-05, Vol.57 (3), p.229-237
• Main Authors: Caro, Mario A., M.D, Rosenthal, Julie L., M.D, Kendall, Kay, M.S.W, Pozuelo, Leopoldo, M.D, Funk, Margo C., M.D., M.A
• Format: Article
• Language: English
• Subjects: Anxiety Disorders - epidemiology; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Automobile Driving; Body Image; Comorbidity; Decision Making; Delirium - epidemiology; Delirium - psychology; Delirium - therapy; Depressive Disorder - epidemiology; Depressive Disorder - psychology; Depressive Disorder - therapy; heart failure; Heart Failure - epidemiology; Heart Failure - psychology; Heart Failure - therapy; Heart Transplantation; Heart-Assist Devices; Humans; Internal Medicine; mechanical circulatory; Mental Disorders - epidemiology; Mental Disorders - psychology; Mental Disorders - therapy; Preoperative Care; Psychiatry; psychopharmacology; psychosocial; Referral and Consultation; Self Care; support; Terminal Care; ventricular assist device
• ISSN: 0033-3182; 1545-7206
• DOI: 10.1016/j.psym.2016.01.002

Background The number of patients with end-stage heart failure utilizing mechanical circulatory support (MCS) has dramatically increased over the last decade. Left ventricular assist devices (LVADs), the most common type of MCS, can be used as a bridge to transplant, destination therapy, and as a bridge to recovery. As this patient population continues to grow, consultation-liaison (CL) psychiatrists will become increasingly involved in their care. A thorough biopsychosocial assessment is required to ensure adequate recognition and management of medical, psychiatric, social, and ethical challenges posed by this population. Methods and Results We performed a literature review to identify key issues relevant to the practice of CL psychiatrists. General functioning of LVADs, device types, system components, life with an LVAD, preoperative evaluation, treatment of psychiatric comorbidities, and end-of-life decision-making are discussed. Conclusions CL psychiatrists need to be familiar with the high prevalence of psychopathology in LVAD patients. A detailed biopsychosocial formulation is required to adequately identify and, if possible, resolve a myriad of medical, psychiatric, social, and ethical challenges presented by this population. Future efforts should be performed to accurately identify and report specific psychiatric disorders and/or adverse events within this cohort.