Costs and Outcomes in the Care of Bi-ventricular Support as a Bridge to Cardiac Transplant

Abstract

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.

Resource Utilization in Pediatric Patients Supported With Ventricular Assist Devices in the United States: A Multicenter Study From the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support and the Pediatric Health Information System

“…The use of VADs in pediatric patients was associated with high resource utilization, with most patients having a hospital LOS greater than 2.5 months, ICU LOS greater than 1.5 months, and total hospital costs of $750 000. These costs are 2‐ to 4‐fold greater than reported costs in adult VAD patients . Additionally, hospital LOS after VAD placement in adults has been decreasing.…”

“…These costs are 2-to 4-fold greater than reported costs in adult VAD patients. [3][4][5][6] Additionally, hospital LOS after VAD placement in adults has been decreasing. Between 2008 and 2011, the mean LOS after VAD implant in the United States was 36 days, less than half the duration that was observed in children.…”

“…Worldwide it is estimated that the current cost of heart failure is over $100 billion . Advanced heart failure care, including ventricular assist devices (VADs), is associated with high resource utilization . VAD use is becoming increasingly common in children with advanced heart failure .…”