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

BACKGROUND: 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. OBJECTIVE: To evaluate longitudinal changes in QOL before and after LVAD implantation and heart transplantation, and to examine associations with physical function. METHODS: 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. RESULTS: 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. CONCLUSION: 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.