Costs and Outcomes in the Care of Bi-ventricular Support as a Bridge to Cardiac Transplant.
Bi-ventricular (Bi-V) mechanical circulatory support is commonly used as a bridge to cardiac transplant. However, the optimal strategy is unknown. We examined the outcomes, as well as the costs in the use of Bi-V support as a bridge to cardiac transplant. From 2001 to 2014, three different Bi-V support strategies were utilized: 1) Para-corporeal ventricular assist device (PVAD-2001-2006), 2) Heartmate II left ventricular assist device in conjunction with a temporary CentriMag right ventricular assist device (HMII + CMAG-2006-2012), and the total artificial heart (TAH-2012-2014). Total costs were derived from the hospitalization at implant, and postimplant costs defined as equipment and re-hospitalizations before transplantation. Sixty-five (34 PVADs, 20 HMII + CMAG, and 11 TAHs) devices were used as a bridge for transplant. There were no differences in implant variables including age, INTERMACS score, or implant length of stay. Although the wait list mortality was not different between groups (PVAD-32%, HMII + CMAG-45%, TAH-54%; p = 0.3), the percentage of patients transplanted were highest in the PVAD group: (PVAD-55.8%, HMII + CMAG-30.0%, TAH-18.2%; p = 0.01). Total costs were not significantly different between groups (PVAD-$306,166 ± 247,839, HMII + CMAG-$278,958 ± 135,324, TAH-$321,387 ± 21,2477; p = 0.5). Despite variations in therapy, outcomes and costs for patients requiring Bi-V support as a bridge to cardiac transplant have remained constant.
From the *University of Rochester, Strong Memorial Hospital, Rochester, New York; and †University of Louisville, Louisville, Kentucky.
Michael F
MF
Swartz
Ron
R
Angona
Karen
K
Smith
Franca
F
Kraenzlin
Christine M
CM
Stypula
Devang
D
Joshi
Vakhtang
V
Tchantchaleishvili
George L
GL
Hicks
H Todd
HT
Massey
D005260:Female; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000191:economics* / Q000401:mortality; D006353:Heart-Assist Devices / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome