Surgical ventricular restoration versus cardiac transplantation: a comparison of cost, outcomes, and survival.
BACKGROUND
Cardiac transplantation is the accepted standard treatment for end-stage heart disease but is donor limited. Surgical ventricular remodeling is an established treatment for patients with ischemic cardiomyopathy. We sought to compare charges, outcomes, and survival in patients undergoing surgical ventricular restoration (SVR) versus cardiac transplantation (CTx).


RESULTS
We retrospectively analyzed hospital charges, length of stay (LOS), and survival for 69 SVR and 53 CTx patients at our institution between January 2002 and June 2005. We also compared New York Heart Association (NYHA) status and Kaplan-Meier survival of our SVR patients with CTx patients with ischemic cardiomyopathy from the International Society of Heart & Lung Transplantation (ISHLT) registry. Median total LOS (12 days vs. 17 days, P = .01) and median postoperative LOS (10 days vs. 15 days, P = .02) were shorter for SVR patients than our CTx patients. Median total hospital charges ($45,506 vs. $137,679, P < .0001) and median total drug charges ($2,625 vs. $15,930, P < .0001) were lower for SVR patients. Significant improvements in ejection fraction were seen after both SVR (27% vs. 37%; P < .0001) and CTx (14% vs. 62%, P < .0001). Furthermore, 91% (49/54) of surviving SVR patients, 98% (44/45) of surviving CTx patients, and 91% of ISHLT CTx patients improved to NYHA Class I/II at follow-up. Survival did not differ between groups.


CONCLUSIONS
SVR patients demonstrate cost-effective clinical improvements that lead to good overall survival. SVR is an excellent surgical option for CHF patients who are not transplant candidates, and should be considered for ischemic cardiomyopathy patients who qualify for transplantation. This strategy may help relieve donor shortage and improve allocation of donor organs.
Williams
Jason A
JA
Johns Hopkins Medical Institutions, Division of Cardiac Surgery, Baltimore, MD 21287-4618, USA.
Weiss
Eric S
ES
Patel
Nishant D
ND
Nwakanma
Lois U
LU
Reeb
Brigitte E
BE
Conte
John V
JV
D000328:Adult; D002302:Cardiac Output / Q000502:physiology; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000191:economics / Q000706:statistics & numerical data; D006352:Heart Ventricles / Q000601:surgery*; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D017202:Myocardial Ischemia / Q000601:surgery*; D051437:Renal Insufficiency / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology