Psychosocial Assessment of Patients Considered for Mechanical Circulatory Support

2019 ◽  
pp. 29-34
Author(s):  
Jenessa S. Price ◽  
Stephanie C. Zanowski
Keyword(s):  
Mental Health ◽  
Social History ◽  
Mechanical Circulatory Support ◽  
Psychosocial Assessment ◽  
Health Clinic ◽  
Circulatory Support ◽  
Psychosocial Risks ◽  
Bridge To Transplant ◽  
Recommendations For Practice ◽  
Transplant Team

Psychosocial assessment is important in evaluating patients for mechanical circulatory support (MCS) for both destination therapy and bridge to transplant. This chapter describes assessments for mental health and substance use, as well as for characterizing social history and overall emotional functioning. It reviews the literature on the psychosocial risks and outcomes among patients being considered for MCS and identifies additional psychological evaluations of interest. It describes a model for assessing and treating these patients that incorporates a mental health clinic dedicated to supporting the MCS-transplant team. Finally, the chapter discusses the challenges in determining MCS candidacy in patients with marked psychosocial risk factors and offers some recommendations for practice.

scholarly journals The Impact of a High-risk Psychosocial Assessment on Outcomes After Durable Mechanical Circulatory Support

ASAIO Journal ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Michelle M. Kittleson ◽  
Heather Barone ◽  
Robert M. Cole ◽  
megan Olman ◽  
Alisa Fishman ◽  
...  
Keyword(s):  
High Risk ◽  
Mechanical Circulatory Support ◽  
Psychosocial Assessment ◽  
Circulatory Support ◽  
The Impact

Abstract 13558: Caregiver Anxiety Reduced From Baseline to 12 Months After Surgery: Findings From the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Circulatory Support ( Sustain-it ) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Petty ◽  
Adin-Cristian Andrei ◽  
Christian Elenbaas ◽  
Anna Warzecha ◽  
Clyde Yancy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Mechanical Circulatory Support ◽  
Treatment Options ◽  
Circulatory Support ◽  
Health State ◽  
Linear Regression Models ◽  
Entire Cohort ◽  
Bridge To Transplant

Introduction: Caregivers (CGs) of heart failure (HF) patients (PTs) who undergo heart transplantation (HT) or Destination Therapy Mechanical Circulatory Support (DT MCS) provide support to PTs before and after surgery, which may affect their own health-related quality of life (HRQOL). In SUSTAIN-IT, we previously reported that CG HRQOL was good at baseline (i.e., before HT and DT MCS surgery) and was impacted by CG comorbidities and CG anxiety. This report explores change in CG overall HRQOL, depression, and anxiety from baseline to 12 months after HT or DT MCS surgery. Methods: From 10/1/15-12/31/18, 13 U.S. centers enrolled 301 CGs of HF PTs: 193 awaiting HT (92 HT with MCS as a bridge to transplant [HT BTT] and 101 HT without MCS [HT non-BTT]), and 108 awaiting DT MCS. At baseline, 3, 6, and 12 months post HT or DT MCS surgery, CGs completed the following instruments: EQ-5D-3L (Visual Analog Scale [VAS]: 0 [worst] to 100 [best] imaginable health state), PHQ-8 (range=0-24; score ≥10=depressive symptoms requiring evaluation), and STAI-State (range=20-80, higher score=more anxiety). Analyses included unadjusted and baseline-adjusted linear regression models. Results: CGs were age 61.0±10.3 years; the majority were Caucasian (86%), female (86%), spouses (85%) of enrolled HF PTs. At baseline, CG EQ-5D-3L VAS and PHQ-8 average scores were 83.8 ± 13.99 (high) and 2.6 ± 2.85 (low), respectively, for the entire cohort. No significant interval changes in CG HRQOL and depressive symptoms were found within or between groups. DT MCS and HT non-BTT CG anxiety significantly decreased over time (baseline to 12 months) (Figure). Levels of CG anxiety were similar among all groups at 12 months after HT or DT MCS surgery. Conclusions: The demonstrated reduction in anxiety among CGs in the post-operative period provides clinicians with important information to share with CGs when PTs are considering surgical treatment options for HF.

scholarly journals Patterns of Use of Temporary Mechanical Circulatory Support as a Bridge to Transplant During the Coronavirus Disease 2019 Pandemic

2020 ◽  
Vol 26 (10) ◽  
pp. 902-904
Author(s):  
Taylor Nordan ◽  
Gregory S. Couper ◽  
Frederick Y. Chen ◽  
Amanda Vest ◽  
David DeNofrio ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Bridge To Transplant ◽  
Patterns Of Use

scholarly journals 174. Temporizing Surgical Measures for Deep Mechanical Circulatory Support Device Infections: Case Series Report

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S110-S110
Author(s):  
Armita Kabirpour ◽  
Daniel G Tang ◽  
Oveimar De laCruz
Keyword(s):  
Heart Transplant ◽  
Mechanical Circulatory Support ◽  
Klebsiella Oxytoca ◽  
Case Series ◽  
Circulatory Support ◽  
Bridge To Transplant ◽  
Surgical Measures ◽  
Support Device ◽  
Mechanical Circulatory Support Device ◽  
Circulatory Support Device

Abstract Background Durable mechanical circulatory support device (MCSD) use continues to grow. MCSD deep-seated infections are a serious complication. Removal of the infected hardware is not always possible. Methods Single institution retrospective review of all culture-proven deep MCSD infection (pump and/or driveline) from 2009–2019. Patients were managed with intravenous (IV) and oral (PO) antibiotics; definitive surgical interventions included incision and drainage (I&D), device replacement, and heart transplant; and temporizing surgical measures were chronic chest tube (CCT) drainage for pump pocket and mediastinum and antibiotic impregnated bead implantation for driveline infection. Outcomes were analyzed. Results Total of 29 patients identified, 23 (79%) were male. Median age at device implantation was 44 years (20–68). MCSD were 18 (62%) destination therapy and 11 (38%) bridge to transplant. MCSD included 1 Heartmate I, 17 Heartmate II, 1 Heartmate III, 4 Heartware HVAD, and 6 Syncardia TAH. The median time to infection of 258 days (43–1551), affecting pump in 8 (28%), pump + driveline in 13 (44%), and driveline in 8 (28%). Microorganisms were S. aureus in 17 (60%, MRSA 11 and MSSA 6); coag-negative staphylococci in 3 (10%); Viridans streptococci in 1; Serratia marcescens in 3; P. aeruginosa in 2; Klebsiella oxytoca in 1; Mycobacterium abscessus in 1 and C. albicans in 1. Antibiotics are given to 28 patients, 23 (80%) with initial IV for a median of 6 weeks (1–14) and 5 (17%) with initial PO, for a median of 7 weeks (2–20). Nineteen patients (83%) on IV received PO antibiotics after. 17 patients (61%) remained on chronic suppression antibiotics (13 PO, 2 IV, 2 PO and IV). Twenty-six (90%) patients had I&D, 6 (21%) had device replacement and 11 (38%) had transplant. Of 21 patients with pump infection 16 (76%) had CCT drainage of pump pocket site or mediastinum for a median of 116 days (range 10–887 days). Of 21 patients with driveline infections, 6 (29%) had antibiotic impregnated bead implants. Overall survival at 90 days was 28/29 (95%) and 24/29 (83%) at 1 year. Infection-related mortality in Table 1. Conclusion Deep MCSD infection remains a challenging clinical problem. CCT drainage (for pump) and antibiotic-impregnated bead implant (for driveline) may be temporizing options for patients unable to undergo timely device replacement or heart transplant. Disclosures All authors: No reported disclosures.

In-Vitro Thrombogenicity Assessment of Mechanical Circulatory Support Devices and Prosthetic Heart Valves

2010 ◽  
Author(s):  
Thomas E. Claiborne ◽  
Gaurav Girdhar ◽  
Jawaad Sheriff ◽  
Jolyon Jesty ◽  
Marvin J. Slepian ◽  
...  
Keyword(s):  
Platelet Activation ◽  
Mechanical Circulatory Support ◽  
Heart Valves ◽  
Anticoagulation Therapy ◽  
Ventricular Assist Devices ◽  
Patient Specific ◽  
Circulatory Support ◽  
Prosthetic Heart Valves ◽  
Bridge To Transplant ◽  
Uncontrolled Bleeding

Mechanical circulatory support (MCS) devices developed for end-stage heart failure or as a bridge-to-transplant include total artificial hearts (TAH) and ventricular assist devices (VAD) and utilize prosthetic heart valves (PHV) or rotary impellers to control blood recirculation [1]. These devices are currently not optimized to reduce the incidence of pathological flow patterns that cause elevated stresses leading to platelet activation and thrombosis. Although the latter is partially mitigated by lifelong anticoagulation therapy, it dramatically increases the risk of uncontrolled bleeding. For instance thromboembolic stroke-related complications (∼2%) were relatively less with the TAH-t compared to uncontrolled bleeding due to anticoagulation use (∼20%) [2]. Platelet activation should therefore be quantified and optimized based on patient-specific cardiac outputs in device prototypes before clinical use.

Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy

ASAIO Journal ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Michael Zaliznyak ◽  
Lily Stern ◽  
Robert Cole ◽  
Adriana Shen ◽  
Keith Nishihara ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Bridge To Transplant

Utility of the Psychosocial Assessment of Candidates for Transplantation (PACT) Scale in Patients Undergoing Mechanical Circulatory Support

2013 ◽  
Vol 19 (8) ◽  
pp. S57
Author(s):  
Meghana Halkar ◽  
Amy S. Nowacki ◽  
Kay Kendall ◽  
Nader Moazami ◽  
Eiran Z. Gorodeski ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Psychosocial Assessment ◽  
Circulatory Support
Sign in / Sign up

Export Citation Format

Share Document