Long-term changes in quality of life with LVAD support and after heart transplantation in advanced heart failure

Improving quality of life (QOL) is a major therapeutic goal for patients with advanced heart failure undergoing left ventricular assist device (LVAD) therapy or heart transplantation. In Japan, prolonged LVAD support due to donor shortage makes long-term QOL outcomes uncertain.

To evaluate longitudinal changes in QOL before and after LVAD implantation and heart transplantation, and to examine associations with physical function.

From 2013 to 2025, 95 patients underwent LVAD implantation at our institution, of whom 23 subsequently received heart transplantation. After excluding 4 patients with incomplete data, 19 were included in the final analysis. QOL was assessed using the Short Form-36 (SF-36) at baseline, during LVAD support, and after transplantation. Physical function was evaluated by grip strength, leg strength, 6-min walk distance (6MWD), and peak oxygen uptake. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were analyzed.

Baseline QOL was impaired in the physical domain but relatively preserved in the mental domain (PCS 22.9 ± 10.4; MCS 49.1 ± 15.0). During LVAD support (mean 64.1 ± 14.1 months), PCS improved significantly (40.1 ± 7.1, p = 0.008), whereas MCS remained stable (52.4 ± 6.3, p > 0.99). After transplantation (mean 33.6 ± 30.4 months), PCS further improved (46.3 ± 7.9, p = 0.006), while MCS continued to remain stable (53.3 ± 5.8, p = 0.466). Post-transplant PCS showed positive but non-significant correlations with physical function measures.

BTT-LVAD and subsequent heart transplantation markedly improve physical QOL in patients with advanced heart failure, while mental QOL, which is relatively preserved at baseline, remains stable throughout long-term follow-up. These findings suggest that, despite stable overall mental well-being, device- and transplant-specific psychological burdens may persist and should be addressed as part of comprehensive long-term care.