MECHANICAL VENTRICULAR ASSISTANCE - AN ECONOMICAL AND EFFECTIVE MEANS OF TREATING END-STAGE HEART-DISEASE

Background. Heightened awareness of medical costs has escalated criticism toward expensive medical therapy. Methods. The use of ventricular assistance devices (VADs) at Pennsylvania State University as a bridge to transplantation was reviewed. Records of 43 patients listed as status I from July 1991 to July 1994 were compared. Results. This analysis demonstrated that for all patients treated with the intent to transplant, those who were bridged with a VAD exhibited a trend toward an improved transplantation rate (92% versus 68%) and a significantly greater rate of discharge from the hospital (92% versus 55.4%; p = 0.023) than the medically managed patients. Although overall charges and costs were higher in VAD-supported patients, this was related to significantly longer pretransplantation hospitalization. When normalized to daily costs and charges, this discrepancy in expenses was eliminated. Conclusions. The superior rate of discharge at equitable daily costs and charges for the VAD patients draws continued enthusiasm toward use of these devices as a bridge to transplantation. Furthermore, development of outpatient care for VAD-supported patients and continued advances in the use of these devices may further reduce the cost of managing these critically ill patients.