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Background Psychosocial factors impact survival in patients undergoing cardiac transplantation, but it is unclear whether they affect outcomes in patients undergoing left ventricular assist device (LVAD) implantation as destination therapy (DT). Methods Patients undergoing DT LVAD at the Mayo Clinic in Rochester, Minnesota from February 2007 to December 2013 were included. Psychosocial characteristics at the time of LVAD implantation were abstracted from the medical record. Andersen-Gill and Cox models were used to examine the association between psychosocial characteristics and all-cause readmission and death, respectively. Patients were censored at death or last follow-up through September 2014. Results Among 136 patients (mean age 64 years, 17% female), most were married/living with a partner (82%), half (55%) had post-high school education, and a history of depression was common (32%). While most patients were former tobacco users (60%) only a small proportion were current tobacco users (10%), had a history of alcohol abuse (16%) or illegal drug use (7%). After a mean follow-up of 2.2 ±1.8 years, 78% of patients had been readmitted (range 0–14 per person) and 49% had died. There were no statistically significant differences in the risk of death according to psychosocial characteristics. However, current tobacco users had lower risk of readmission (adjusted HR 0.57, 95% CI 0.38–0.88), while illegal drug use (HR 1.55, 95% CI 1.01–2.35) and depression (HR 1.77, 95% CI 1.40–2.22) were associated with higher readmission risk. Conclusions Psychosocial characteristics are not significant predictors of death, but are associated with readmission risk after DT LVAD.

The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.

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