Living with a left ventricular assist device: psychological burden and coping: protocol for a cross-sectional and longitudinal qualitative study.

INTRODUCTION: Due to technological progress and persistent shortage of donor hearts, left ventricular assist devices (LVADs) have become established in the treatment of advanced heart failure. Accordingly, more patients live with LVADs for prolonged periods. Related research focused primarily on clinical issues and little is known about psychosocial aspects of living with an LVAD. This study aims to explore psychological burden and coping following LVAD implantation. METHODS AND ANALYSIS: An exploratory qualitative study with cross-sectional and longitudinal elements will be carried out. At least 18 patients with LVAD who have the device implanted from a few weeks to more than 3 years will be interviewed in the cross-sectional component using an interview guide. A subsample of patients who live with the LVAD for up to 3 months when recruited will be interviewed two additional times in the following year. The cross-sectional interviews will be analysed using an inductive qualitative content analysis to describe psychological burden, coping resources and behaviour from the patient's perspective. Based on the findings, the longitudinal interviews will be analysed with a deductive content analysis to explore psychological adjustment during the first year after implantation. The findings will provide a deeper understanding of the complex and specific situation of patients with LVAD and of psychological adjustment to living with a life-sustaining implant. This can help clinicians in considering individual aspects to promote patient outcomes and is the basis for further research on healthcare interventions or technical solutions to reduce burden and for developing rehabilitation measures to promote psychosocial outcomes. ETHICS AND DISSEMINATION: Ethical approval was obtained from the ethics committee of the School of Medicine and Health Sciences at the University of Oldenburg (2019-023). Study findings will be disseminated at national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER: German Clinical Trials Register (DRKS00016883).

Total aortic arch replacement using elephant trunk or frozen elephant trunk technique: a case-control matching study.

BACKGROUND: Surgical management of aortic arch diseases is one of the most challenging issues in cardiovascular surgery. The aim of this study was to compare the outcome after frozen elephant trunk (FET) with conventional elephant trunk (ET) technique. METHODS: Out of a total of 551 patients after thoracic aortic surgery, we analyzed 70 consecutive patients, who underwent aortic arch replacement with ET or FET technique between 2001 and 2017 in our institution. The patients were case-control matched in regard to such variables as age, sex, presence of an acute aortic dissection and necessity for concomitant procedures. The analysis included 25 patient pairs. RESULTS: Among the 25 FET patients, eleven patients were female, the median age was 69, 15 (60%) patients had an aortic dissection and thirteen needed various concomitant procedures. In the second group, treated with conventional ET technique, 10 (40%) patients were female, the median age was 66 years, thirteen presented with an aortic dissection and 16 (64%) underwent concomitant procedures. These and other characteristics did not differ significantly between the groups. In-hospital mortality was statistically similar: 5 (20%) in the FET group vs. 8 (32%) for ET group (P=0.52). The incidence of stroke, acute renal failure and postoperative bleeding was comparable. The length of stay in the intensive care unit did not differ between the cohorts (P=0.258). Predictors of in-hospital mortality were length of the operation, bleeding postoperatively, and acute renal failure. The one-year survival rates were higher in the FET cohort compared to the conventional approach (60% vs. 38%), however without statistical significance. CONCLUSION: In regard to the short- and mid-term outcome, there were only slight differences between both techniques. In patients with extensive aneurysmal aortic disease, conventional ET and FET procedures seem to be associated with acceptable satisfactory mid-term outcome.