Case report: Neuropsychological therapy for patient with a total artificial heart

Introduction: In Germany the number of patients on the waiting list for a donor heart is increasing because of the scarcity of organ donations. In order to survive the time on the waiting list, more and more patients are in need of a mechanical circulation support (MCS) as a bridge to transplant. Neurological complications in MCS patients with ventricular assist devices (VAD) or total artificial hearts (TAH) are repeatedly reported. This case report describes the specific and helpful role of neuropsychological therapy for this patient group.

Case report: We report about a 53 year old German male patient with an ischemic cardiomyopathy and cardiogenic shock in need of a total artificial heart -

CardioWest ™ TAH as a bridge to transplant. Acute ischemic attacks (ateria cerebri media (ACM) and part of ateria cerebri anterior right) and a subacute stroke (arteria cerebri posterior, right occipital) were diagnosed postoperative. After neurological rehabilitation, his health status was classified as high urgent for heart transplantation. During the following weeks the patient suffered an acute stroke (ACM, left). The neuropsychological therapy concentrated on the multimodal neglect to his left and the anosognosia for the hemiparesis left. The therapy was complicated by the changing body image with TAH and the patient's focus on the constant pulsation of the pump and the ever-lasting noise of the TAH. The visual perception of the system as a whole was trained. Due to orthostatic dysregulation of the cardiovascular system, mobilization into an upright position was not possible for a long time. After a left hemispheric stroke the therapy had to be extended to treating aphasic symptoms. The pump related pulsation of the whole body made it difficult for the patient to find the right possible speaking rhythm to articulate. The psychological illness process and the realization of life dependency on the TAH, helplessness and anxiety about the future also represent a main focus for the psychological therapy.

Conclusion: The patient's perceived self-control, which is an indicator for quality of life in MCS patients, was strengthened by neuropsychological diagnostics and therapy. Further, back to normality, self-assurance and emotional stability were supported by this therapy and it supplied important information for the adjustment of the TAH and INR-self measurement education program.