Quality of life for patients supported on a left ventricular assist device

Left ventricular assist devices (LVADs) are mechanical pumps implanted into patients at risk of dying from Stage D heart failure. These devices not only increase survival time, they also significantly improve quality of life. Implantation of a LVAD improves hemodynamics and reduces congestion in both the pulmonary and peripheral vasculature. Improvements in forward blood flow are probably responsible for the significant reduction in the severity of dyspnea and fatigue postimplant. Quality of life is a subjective evaluation and includes aspects of physical, mental and social functioning. Quality of life is significantly improved after implantation of a LVAD, changes little over the duration of support and improves again following heart transplantation. Patients who are discharged home on support report significantly better quality of life than patients who remain in hospital. At home patients can resume physical, mental and social activities that were compromised preimplant. A significant decline in functional ability while on support may be a trigger for patients to initiate discussions regarding LVAD withdrawal. While the bulk of evidence was generated during the era of pulsatile support, preliminary information suggests similar results can be anticipated for patients supported on continuous-flow devices.