Future of Mechanical Circulatory Support

Insanity of Left Ventricular Assist Therapy

“…Now that current LVAD’s are sufficiently small, quiet, and durable; and that serious complications of infection and thromboembolic events have been mitigated, we must look to a different metric of success. 5 Which is precisely what Oppenheimer & Co. did in a recent (May 2011) survey of cardiac surgeons. 6 When asked “what are the greatest factors driving wider adoption of LVADs for destination therapy?” the overwhelming response was… “Portability and device wear profile.” Not “small size,” “easier implant strategy,” and “cost” — which were in fact at the very bottom of the list.…”

Complex HeartMate II Infection Treated with Pump Exchange to HeartWare HVAD

“…There is evidence that the 5 year cost of transplantation and chronic LVAD/biventricular assist device use is very similar (~$300K vs. ~$350K, respectively). 13 Oz et al 14 have analyzed readmission costs in VAD patients and found the average annual cost of readmission to be on the order of $100,000 per patient. In the current era of cost conscientious care, every effort must be made to avoid infection and readmission, a point clearly made in a UK study in which the statement was made that "the recommendation for HMII LVAD implantation to transplant candidates lacks justification in terms of cost-effectiveness."…”