Background: Heart transplantation imposes significant stress on couple dynamics; however, relational resilience in this context has been less systematically conceptualized. This scoping review aimed to map the literature, identify research gaps, and develop a conceptual model of relational resilience in couples experiencing life-threatening cardiac illnesses.
Methods & Materials: A systematic search was conducted in PubMed, Scopus, Web of Science, PsycINFO, and Google Scholar using combined keywords related to heart transplantation, life-threatening illnesses, couple dynamics, relational resilience, and dyadic coping, without time restriction up to June 2026. This scoping review was performed based on the Arksey and O'Malley (2005) framework. Data were synthesized through inductive thematic analysis with an integrative approach (combining quantitative and qualitative findings at the theme level).
Results: From 788 initial sources, 17 studies (10 quantitative, 7 qualitative) were included. The analysis led to the extraction of six main themes: (1) The negative and persistent impact of heart transplantation on couple relationship quality, emphasizing the distinct experience of spouses (deterioration in four domains: role functioning, communication, emotional involvement, and values); (2) Spousal support as the strongest predictor of clinical success (the caregiving paradox); (3) Five distinct patterns of physical health changes in spouse caregivers; (4) The direct effect of patient mental health on spouse caregiver health without moderating effect of social support; (5) The triadic nature of spouses' experience including intense responsibility, striving for connection, and struggling with the prospect of the beloved's death; and (6) The mediating role of positive dyadic coping in the relationship between psychological distress and relationship quality.
Conclusion: The proposed conceptual model explains relational resilience in couples with life-threatening cardiac illnesses through five key characteristics: dynamic, interactionist, contextual, cyclical, and multilevel. These findings emphasize the necessity of shifting from individual-centered to relationship-centered models in post-heart transplantation care. Mental health professionals should comprehensively assess couple status and design interventions focused on strengthening shared coping and mutual support to prevent physical and psychological burnout in spouse caregivers.