Left Ventricular Assist Devices as Permanent Heart Failure Therapy

Öz, Mehmet C.; Gelijns, Annetine C.; Miller, Leslie W.; Wang, Cuiling; Nickens, Patrice Desvigne; Arons, R. M.; Aaronson, Keith D.; Richenbacher, Wayne E.; Meter, Clifford Van; Nelson, Karl E.; Weinberg, Alan; Watson, John T.; Rose, Eric A.; Moskowitz, Alan J.

doi:10.1097/01.sla.0000090447.73384.ad

Cited by 111 publications

(73 citation statements)

References 14 publications

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“…However, the principal limitations of VADs as long-term treatment approaches for heart failure are those affecting any non-endothelialized foreign body: (1) infection, and (2) thromboembolic and bleeding complications (Oz et al, 2003). These data are well documented in a prospective, randomized clinical trial (REMATCH Rose et al, 2001).…”

Section: Ventricular Thrombosismentioning

confidence: 71%

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

Mohan

Rajagopal

2003

Computational and Mathematical Methods in Medicine

142

121

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Multiple interacting mechanisms control the formation and dissolution of clots to maintain blood in a state of delicate balance. In addition to a myriad of biochemical reactions, rheological factors also play a crucial role in modulating the response of blood to external stimuli. To date, a comprehensive model for clot formation and dissolution, that takes into account the biochemical, medical and rheological factors, has not been put into place, the existing models emphasizing either one or the other of the factors. In this paper, after discussing the various biochemical, physiologic and rheological factors at some length, we develop a model for clot formation and dissolution that incorporates many of the relevant crucial factors that have a bearing on the problem. The model, though just a first step towards understanding a complex phenomenon, goes further than previous models in integrating the biochemical, physiologic and rheological factors that come into play.

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Section: Ventricular Thrombosismentioning

confidence: 71%

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

Mohan

Rajagopal

2003

Computational and Mathematical Methods in Medicine

142

121

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“…However, other CE studies confirmed that the main cost drivers in this population are the devices, the procedure and the post‐procedure complications costs 26. In the Oslo University experience, medical therapy represented 1% of total costs during the pre‐LVAD and the LVAD phase and was insignificant during the post‐LVAD phase 10.…”

Section: Discussionmentioning

confidence: 85%

Cost‐effectiveness of left ventricular assist devices for patients with end‐stage heart failure: analysis of the French hospital discharge database

Tadmouri¹,

Blomkvist²,

Landais³

et al. 2017

ESC Heart Failure

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AimsAlthough left ventricular assist devices (LVADs) are currently approved for coverage and reimbursement in France, no French cost‐effectiveness (CE) data are available to support this decision. This study aimed at estimating the CE of LVAD compared with medical management in the French health system.Methods and resultsIndividual patient data from the ‘French hospital discharge database’ (Medicalization of information systems program) were analysed using Kaplan–Meier method. Outcomes were time to death, time to heart transplantation (HTx), and time to death after HTx. A micro‐costing method was used to calculate the monthly costs extracted from the Program for the Medicalization of Information Systems. A multistate Markov monthly cycle model was developed to assess CE. The analysis over a lifetime horizon was performed from the perspective of the French healthcare payer; discount rates were 4%. Probabilistic and deterministic sensitivity analyses were performed. Outcomes were quality‐adjusted life years (QALYs) and incremental CE ratio (ICER). Mean QALY for an LVAD patient was 1.5 at a lifetime cost of €190 739, delivering a probabilistic ICER of €125 580/QALY [95% confidence interval: 105 587 to 150 314]. The sensitivity analysis showed that the ICER was mainly sensitive to two factors: (i) the high acquisition cost of the device and (ii) the device performance in terms of patient survival.ConclusionsOur economic evaluation showed that the use of LVAD in patients with end‐stage heart failure yields greater benefit in terms of survival than medical management at an extra lifetime cost exceeding the €100 000/QALY. Technological advances and device costs reduction shall hence lead to an improvement in overall CE.

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“…Infections in these patients also incur a higher economic burden as these patients tend to have longer recovery time and require more hospitalizations [5]. Cost analysis also shows that sepsis is the most important predictor of cost [6]. Antimicrobial topical wound care for CF-LVADs is a simple intervention that is now routine despite the paucity of research on its efficacy.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Acticoat-Silver Dressing in Preventing Left-entricular-Assisted Device Infections

Zainah¹,

Karthikeyan²,

Buitron³

et al. 2016

Immunochem Immunopathol

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Background: The optimal local care of continuous-flow left ventricular-assisted device (CF-LVAD) exit site in unclear. We compared silver-coated wound dressing (Acticoat) with the conventional wound care method. Methods:A retrospective case-control study was conducted at Henry Ford Hospital, a tertiary teaching hospital in urban Detroit, between 11/1/2010 and 12/31/2011. Patients were divided into 2 groups based on Acticoatdressing use. Primary outcome was first CF-LVAD infection rate.Results: Forty-two patients were included in the study. Twenty patients used Acticoat-dressing, while 22 used the control dressing. Mean age was 60.3 ± 8.9 in the intervention group and 48.6 ± 4.8 in the control group (P: 0.004). Male patients were 15 (75%) in the intervention group and 15 (68.2%) in the control group (P: 0.74). Acticoat-dressing was used for a mean duration of 64.1 ± 122.9 days. The rate of first CF-LVAD infection was 15% (3) in the Acticoat group and 31.8% (7) in the control group (P: 0.25). Mortality at 200 days was 15% (3) in the intervention group; and 4.5% (1) in the control group (P: 0.25). Ten patients were infected in the whole study (23.8%); 9 of the infected patients (90%) required hospitalization after the first infection; while 3 patients (30%) required intensive-care unit admission. Mean time to the first infection was 276.3 ± 235.8 days in the intervention group and 276.3 ± 131.5 days in the control group (P: 0.99).

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Left Ventricular Assist Devices as Permanent Heart Failure Therapy

Abstract: The cost of long-term LVAD implantation is commensurate with other life-saving organ transplantation procedures like liver transplantation. As an evolving technology, there are a number of opportunities for improvement that will likely reduce costs in the future.

Cited by 111 publications

References 14 publications

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

Cost‐effectiveness of left ventricular assist devices for patients with end‐stage heart failure: analysis of the French hospital discharge database

The Efficacy of Acticoat-Silver Dressing in Preventing Left-entricular-Assisted Device Infections

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