The objective of this study is to investigate the long-term psychological aftermaths of the implantation of a ventricular assist device as bridge to successful heart transplantation. Cross-sectional, retrospective assessment of 30 patients (aged 48.1 ± 11.5 years, m/f = 28/2, 64.8 ± 32.2 months, range 12-134 months after transplantation) and 21 partners (m/f = 1/20) by standardized instruments [Impact of Event Scale (IES-R), Hospital Anxiety and Depression Scale] and a questionnaire about specific problems regarding the time on the device (Artificial Heart Questionnaire) at Vienna Transplant Center (Austria) were used. Twenty patients suffered from dilatative cardiomyopathy and 10 of ischemic cardiomyopathy. The assist remained implanted for 158 ± 130 days (range 28-711). After transplantation, patients had to stay in Coronary care unit for 8.5 ± 7.3 days (range1-40) and remained in hospital for 29.8 ± 7.9 days (range 21-51) before they were transferred to a rehabilitation unit. None of the patients but 23 per cent of the partners (n = 6) met the criteria for post-traumatic stress disorder (Maercker cut-off > 0). Thereby, the IES-R sum scales differed significantly between the two groups [21.2 ± 15.1 (mean ± standard deviation) for patients versus 38.1 ± 27.8 for partners, respectively, p = 0.001]. Two per cent of the patients and 19 per cent (p = 0.055) of the partners showed mild to moderate depression, and 4 per cent of patients and 23 per cent (p = 0.007) of their partners reported mild to moderate anxiety. None of the results were significantly influenced by the time elapsed since transplantation, the patients' age, diagnoses or indication for heart transplantation. However, the type of assist device had significant effects on hyperarousal (p = 0.040), avoidance (p = 0.030), sum scale (p = 0.050) and IES-R-cut-offs (p = 0.039) of the spouses. Concerning the specific heart support related questions, patients rated all the items lower than did their respective spouses. These values significantly were lower for pain (p = 0.034) and stroke (p = 0.008) in spouses than patients. Despite of patients being much closer to a life threat, it is their partners who experience significantly more psychological distress even in the long run. Our findings highlight the need to support the supporting persons. Copyright © 2008 John Wiley & Sons, Ltd.