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.
Baseline quality of life was severely impaired in the physical domain but relatively preserved in the mental domain prior to LVAD implantation.
Physical QOL improved significantly during LVAD support, while mental QOL remained stable.
Physical QOL continued to improve significantly after heart transplantation, while mental QOL remained stable.
Post-transplant physical QOL showed positive but non-significant correlations with objective physical function measures.
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.
In Japan, prolonged LVAD support due to donor shortage creates a context of long-term bridge-to-transplant (BTT) use with uncertain QOL outcomes.
This research examined how quality of life (QOL) changes over time in patients with severe heart failure who received a left ventricular assist device (LVAD) — a mechanical heart pump — and later underwent a heart transplant. The study followed 19 patients at a Japanese hospital between 2013 and 2025, measuring both physical and mental aspects of QOL at three timepoints: before LVAD implantation, during LVAD support (which lasted an average of over 5 years due to limited organ donation in Japan), and after heart transplantation. The study found that before receiving an LVAD, patients had severely reduced physical quality of life but relatively normal mental quality of life. Physical QOL improved significantly once the LVAD was implanted and continued to improve further after heart transplantation. Mental QOL, which started at a near-normal level, stayed stable throughout — neither worsening nor improving at any stage. Physical fitness measures like grip strength and walking distance showed positive trends after transplantation, though these were not statistically significant in this small sample. This research suggests that both LVAD therapy and heart transplantation offer meaningful improvements in how physically capable and comfortable patients feel in daily life, even after years of living with a mechanical heart pump. However, the authors caution that stable mental health scores may mask specific emotional burdens tied to living with a device or going through transplantation, and that psychological support should be a routine part of care for these patients. The findings are particularly relevant in countries like Japan where patients may spend many years waiting for a donor heart while supported by an LVAD.
Kobayashi K, Yoshizumi T, Tokuda Y, Takagi D, Hattori K, Hayashi Y, et al.. (2026). Long-term changes in quality of life with LVAD support and after heart transplantation in advanced heart failure.. BMC cardiovascular disorders. https://doi.org/10.1186/s12872-025-05500-2