Severing your lifeline: The impact of neuropsychiatric conditions after left ventricular assist device implantation

摘要

A 47-year-old female with a history of peripartum cardio-myopathy and HeartMate-ll LVAD (Thoratec Corporation, Pleasanton, CA, USA) implantation presented with a broken driveline associated with foul smelling discharge. The LVAD was implanted three years ago at an outside institution and her pre-implant psychosocial evaluation revealed stable mood, normal cognition, and appropriate family support. She had a chronic driveline infection and eighteen months after implantation she suffered an ischemic stroke. She experienced psychosocial problems: mild depression, financial stressors, and divorce. She progressively became non-compliant with her medications (lisinopril, metoprolol, aspirin, and warfarin) and follow-up. She had cut the drive-line two weeks prior to presentation to our center as she was "fed up with it and no longer needed it" (Fig. 1 A).