title: Long-term prognosis and cost-effectiveness of left ventricular assist device as bridge to transplantation: A systematic review.
abstract: BACKGROUND
  This systematic review aimed to evaluate the clinical outcomes and cost-effectiveness of left ventricular assist devices (LVADs) used as bridge to transplantation (BTT), compared to orthotopic heart transplantation (OHT) without a bridge.
  
  
  METHODS
  Systematic searches were performed in electronic databases with available data extracted from text and digitized figures. Meta-analysis of short and long-term term post-transplantation outcomes was performed with summation of cost-effectiveness analyses.
  
  
  RESULTS
  Twenty studies reported clinical outcomes of 4575 patients (1083 LVAD BTT and 3492 OHT). Five studies reported cost-effectiveness data on 837 patients (339 VAD BTT and 498 OHT). There was no difference in long-term post-transplantation survival (HR 1.24, 95% CI 1.00-1.54), acute rejection (HR 1.10, 95% CI 0.93-1.30), or chronic rejection and cardiac allograft vasculopathy (HR 0.99, 95% CI 0.73-1.36). No differences were found in 30-day post-operative mortality (OR 0.91, 95% CI 0.42-2.00), stroke (OR 1.64, 95% CI 0.43-6.27), renal failure (OR 1.43, 95% CI 0.58-3.54), bleeding (OR 1.56, 95% CI 0.78-3.13), or infection (OR 2.44, 95% CI 0.81-7.38). Three of the five studies demonstrated incremental cost-effectiveness ratios below the acceptable maximum threshold. The total cost of VAD BTT ranged from $316,078 to $1,025,500, and OHT ranged from $179,051 to $802,200.
  
  
  CONCLUSIONS
  LVADs used as BTT did not significantly alter post-transplantation long-term survival, rejection, and post-operative morbidity. LVAD BTT may be cost-effective, particularly in medium and high-risk patients with expected prolonged waiting times, renal dysfunction, and young patients.
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Seco
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.
authors.forename: Dong Fang
authors.initials: DF
authors.lastname: Zhao
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Byrom
authors.affiliation: The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Fraser
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia. Electronic address: paul.bannon@sydney.edu.au.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
mesh_terms: D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016896:Treatment Outcome
keywords: Bridge-to-transplantation; Heart transplantation; Left ventricular assist device; Meta-analysis; Systematic review