Abstract P334: Comparative Effectiveness of Left Ventricular Assist Devices as a Bridge to Heart Transplantation

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Left ventricular assist devices (LVAD) have evolved to be more frequently utilized in patients with advanced congestive heart failure as a bridge to heart transplantation. In the era of limited healthcare resources and diminishing funding for innovative technologies, there is little data to evaluate the comparative effectiveness of LVADs in comparison to more conventional heart failure therapies leading to heart transplantation without mechanical circulatory support. Objective . To evaluate the clinical outcomes, complications, length of stay, financial impact and satisfaction of patients with advanced heart failure undergoing heart transplantation as part of a comprehensive heart failure program with or without LVAD as a bridge to transplant (BTT). Methods We retrospectively reviewed 25 patients undergoing heart transplantation from 2009–2010 (12 patients without LVAD, 13 with LVAD as BTT). Inpatient hospital, financial and clinic records were reviewed to evaluate length of stay, morbidity, mortality, DRG assignment, insurance status, charges and cost, reimbursement and patient satisfaction. All patients received surveys assessing their satisfaction with the mechanical circulatory support and transplant program. Results There were 14 males and 11 females (avg age 54 ).In the non- LVAD group, 9 patients fell into DRG 1 ,3 were in DRG 2;in the LVAD group, 10 patients fell in DRG 1, 3 patients were in DRG 2.Complications occurring in the LVAD patients included pneumonia (2),CVA, depression, rejection and bowel perforation ;in the non-LVAD patients pneumonia, pulmonary embolus, aspergillosis, peri-rectal abscess and failure to thrive; Mortality at 1 year occurred in 2 patients after LVAD; 1 patient after transplant without LVAD. All patients responded that they were very satisfied with the advanced heart failure program whether they received LVAD prior to transplant or not Conclusions Transplant recipients with advanced heart failure have comparable clinical outcomes after transplant whether they required LVAD implantation prior to transplant. Perioperative care algorithms focused on reduction of common post-operative complications resulting in significant financial impact (ie pulmonary), should be developed to address these issues.