Heart Transplant vs Left Ventricular Assist Device in Heart Transplant-Eligible Patients

Williams, Matthew Leighton; Trivedi, Jaimin R.; McCants, Kelly C.; Prabhu, Sumanth D.; Birks, Emma J.; Oliver, Laurie; Slaughter, Mark S.

doi:10.1016/j.athoracsur.2011.01.062

Cited by 51 publications

(40 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9 Costs of cardiac transplantation and VAD are from a single center analysis of cost and include only inpatient costs of these therapies. 7,28 Thus, the total cost of transplantation with 10-month follow-up is underestimated. Figure 3.…”

Section: Pulsatile Flow Lvads As Destination Therapymentioning

confidence: 99%

Cost of Ventricular Assist Devices

2013

View full text Add to dashboard Cite

Section: Pulsatile Flow Lvads As Destination Therapymentioning

confidence: 99%

Cost of Ventricular Assist Devices

2013

View full text Add to dashboard Cite

“…Similar post-transplant mortality rates were used for patients who received IDMT or LVAD pretransplantation. 11,[16][17][18] The median wait-list time to receive a heart in the United States was 5.6 months based on the Scientific Registry of Transplant Recipients (SRTR). 12 In our model, we randomly generated a different wait-list time for each patient, such that the median wait time is 5.6 months.…”

Section: Survival Ratesmentioning

confidence: 99%

Comparative Survival and Cost-Effectiveness of Advanced Therapies for End-Stage Heart Failure

Long

Swain

Mangi

2014

Circ: Heart Failure

118

View full text Add to dashboard Cite

Background— Treatment options for end-stage heart failure include inotrope-dependent medical therapy, orthotopic heart transplantation (OHT), left ventricular assist device (LVAD) as destination therapy or bridge to transplant. Methods and Results— We developed a state-transition model to simulate 4 treatment options and associated morbidity and mortality. Transition probabilities, costs, and utilities were estimated from published sources. Calculated outcomes included survival, quality-adjusted life-years, and incremental cost-effectiveness. Sensitivity analyses were performed on model parameters to test robustness. Average life expectancy for OHT-eligible patients is estimated at 1.1 years, with 39% surviving to 1 year. OHT with a median wait time of 5.6 months is estimated to increase life expectancy to 8.5 years, and costs <$100 000/quality-adjusted life-year gained, relative to inotrope-dependent medical therapy. Bridge to transplant-LVAD followed by OHT further is estimated to increase life expectancy to 12.3 years, for $226 000/quality-adjusted life-year gained versus OHT. Among OHT-ineligible patients, mean life expectancy with inotrope-dependent medical therapy is estimated at 9.4 months, with 26% surviving to 1 year. Patients who instead received destination therapy-LVAD are estimated to live 4.4 years on average from extrapolation of recent constant hazard rates beyond the first year. This strategy costs $202 000/quality-adjusted life-year gained, relative to inotrope-dependent medical therapy. Patient’s age, time on wait list, and costs associated with care influence outcomes. Conclusions— Under most scenarios, OHT prolongs life and is cost effective in eligible patients. Bridge to transplant-LVAD is estimated to offer >3.8 additional life-years for patients waiting ≥6 months, but does not meet conventional cost-effectiveness thresholds. Destination therapy-LVAD significantly improves life expectancy in OHT-ineligible patients. However, further reductions in adverse events or improved quality of life are needed for destination therapy-LVAD to be cost effective.

show abstract

“…After removal of duplicates, we assess for eligibility 2,849 studies. We excluded 2,809 studies based on their title and abstract and 40 articles were retrieved for full-text review, before resulting in the eight eligible studies (11)(12)(13)(14)(15)(16)(17)(18). The detailed flow diagram is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Theochari¹,

Michalopoulos²,

Oikonomou³

et al. 2018

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Background: The optimal treatment for advanced heart failure (HF) patients with regards to mortality remains unknown. Heart transplantation (HTx) and left ventricular assist devices (LVAD) used either as a bridge to transplant (BTT) or destination therapy (DT) have been compared in a number of studies, without definite conclusions with regards to mortality benefit. We sought to systematically review the pertinent literature and perform a meta-analysis of all the available studies presenting head-to-head comparisons between HTx and LVAD BTT or LVAD DT for late (>6 months) all-cause mortality.Methods: We performed a systematic search of Medline and Cochrane Central databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a meta-analysis of late mortality comparing HTx vs. BTT LVAD and HTx vs. DT LVAD using a random effects model.Results: Eight studies were included in our meta-analysis, reporting data on 7,957 patients in total.Although the available studies are of high quality [8 stars in Newcastle-Ottawa Scale (NOS) on average], there is paucity of mortality data. Specifically, seven studies compared HTx with BTT and five studies compared HTx with DT for 1-year mortality. Our pooled estimates showed that there was no difference in late mortality among these strategies. Conclusions:Our meta-analysis highlights the small number and the heterogeneity of available studies referring to the optimal invasive management of advanced HF, and shows that there are no differences between HTx and LVAD for these patients with regards to late mortality.

show abstract

Heart Transplant vs Left Ventricular Assist Device in Heart Transplant-Eligible Patients

Cited by 51 publications

References 4 publications

Cost of Ventricular Assist Devices

Cost of Ventricular Assist Devices

Comparative Survival and Cost-Effectiveness of Advanced Therapies for End-Stage Heart Failure

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Contact Info

Product

Resources

About