Speciality
Spotlight

 




 


Cardiology


 


   





Cardiac Transplantation

    

  • Hershberger RE[ Health Sciences Univ, Portland Ore]

    Clinical Outcomes, Quality of Life, and Cost Outcomes, After Cardiac Transplantation

    Am J Med Sci 314: 129-138, 1997

         

    Improving survival is the most compelling reason for cardiac transplantation in patients with advanced heart failure, particularly those dependant on intravenous inotropic support or mechanical assistance. This procedure, however, is not curative; rather, it remains a treatment modality requiring indefinite immunosuppression and ongoing care. The cost of cardiac transplantation was also investigated.

        

    Primarily cardiac transplantation should be considered because it improves survival. For patients with advanced disease treated with enalapril, the mortality was 40% at 1 year. Patients with Class III or IV heart failure at initial evaluation, had a 1-year mortality rate of 16%. Survival for cardiac transplantation at 1 year was 81.8%.

        

    Improved quality of life has been found after heart transplantation in most studies, with less total symptom distress, better health perception, better overall functional status, and more satisfaction with life. The most common area of disability after transplantation was work-related. Employment rates varied from 32% to 50% after transplantation. 

      

    At the time of this study in 1998, cost of heart transplantation from date of transplant to date of discharge, was about $ 91,600. Only 2500 hearts are available for transplantation per year; although 40,000 patients await donors; this affects cost outcomes. A median waiting period of 122 days for a heart transplant, results in patients getting sicker, thus further raising the cost of transplantation. The left ventricular assist device [LVAD] has become the most advanced technology to bridge the gap to cardiac transplantation, with the cost ranging from $ 30,000 to $ 60,000.

         
  • DeRose JJ, Jr, Umana JP, Argenziano M, et al [ Columbia Univ, New York]

    Implantable Left Ventricular Assist Devices Provide an Excellent Out-patient Bridge to Transplantation and Recovery

    J Am Coll Cardiol 30 : 1773-1777, 1997

        

    The limited donor pool makes heart transplantation available for only 2500 patients every year. Left ventricular assist devices [ LVADs] have been successfully used as a bridge to transplantation for 10 years. Recent experience with out-patient LVAD support demonstrates the possibilities and limitations of long-term out-patient mechanical circulatory assistance.

         

    Thirty-two patients underwent implantation of the Thermo Cardiosystem Heartmate vented electric LVAD during 1993 and 1994. This device is powered by batteries worn on shoulder holsters and is operated by a belt-mounted system controller that allows unrestricted patient ambulation and hospital discharge.

         

    Mean duration of LVAD support was 122 days [ range 3 to 605 days]. The survival rate to transplantation or explantation was 78%. Nineteen patients were discharged from hospital at a mean postoperative time of 41 days [ range 17 to 68 days]. Out-patient support time was a mean of 108 days [ range 2 to 466 days]. Because of early transplantation, four patients were not available to participate in the discharge program. At final follow-up, three patients were awaiting discharge. The complication rate in the series was similar to an earlier series of 52 patients with a pneumatic LVAD.

      

    Outpatient LVAD support is safe and offers improved quality of life for patients awaiting heart transplantation. Wearable and totally implantable LVADs should be evaluated as permanent treatment options in patients who are not candidates for heart transplantation.

        




 

 

Speciality Spotlight

 

   

Cardiac Transplantation
    

  • Hershberger RE[ Health Sciences Univ, Portland Ore]
    Clinical Outcomes, Quality of Life, and Cost Outcomes, After Cardiac Transplantation
    Am J Med Sci 314: 129-138, 1997
         
    Improving survival is the most compelling reason for cardiac transplantation in patients with advanced heart failure, particularly those dependant on intravenous inotropic support or mechanical assistance. This procedure, however, is not curative; rather, it remains a treatment modality requiring indefinite immunosuppression and ongoing care. The cost of cardiac transplantation was also investigated.
        
    Primarily cardiac transplantation should be considered because it improves survival. For patients with advanced disease treated with enalapril, the mortality was 40% at 1 year. Patients with Class III or IV heart failure at initial evaluation, had a 1-year mortality rate of 16%. Survival for cardiac transplantation at 1 year was 81.8%.
        
    Improved quality of life has been found after heart transplantation in most studies, with less total symptom distress, better health perception, better overall functional status, and more satisfaction with life. The most common area of disability after transplantation was work-related. Employment rates varied from 32% to 50% after transplantation. 
      
    At the time of this study in 1998, cost of heart transplantation from date of transplant to date of discharge, was about $ 91,600. Only 2500 hearts are available for transplantation per year; although 40,000 patients await donors; this affects cost outcomes. A median waiting period of 122 days for a heart transplant, results in patients getting sicker, thus further raising the cost of transplantation. The left ventricular assist device [LVAD] has become the most advanced technology to bridge the gap to cardiac transplantation, with the cost ranging from $ 30,000 to $ 60,000.
         
  • DeRose JJ, Jr, Umana JP, Argenziano M, et al [ Columbia Univ, New York]
    Implantable Left Ventricular Assist Devices Provide an Excellent Out-patient Bridge to Transplantation and Recovery
    J Am Coll Cardiol 30 : 1773-1777, 1997
        
    The limited donor pool makes heart transplantation available for only 2500 patients every year. Left ventricular assist devices [ LVADs] have been successfully used as a bridge to transplantation for 10 years. Recent experience with out-patient LVAD support demonstrates the possibilities and limitations of long-term out-patient mechanical circulatory assistance.
         
    Thirty-two patients underwent implantation of the Thermo Cardiosystem Heartmate vented electric LVAD during 1993 and 1994. This device is powered by batteries worn on shoulder holsters and is operated by a belt-mounted system controller that allows unrestricted patient ambulation and hospital discharge.
         
    Mean duration of LVAD support was 122 days [ range 3 to 605 days]. The survival rate to transplantation or explantation was 78%. Nineteen patients were discharged from hospital at a mean postoperative time of 41 days [ range 17 to 68 days]. Out-patient support time was a mean of 108 days [ range 2 to 466 days]. Because of early transplantation, four patients were not available to participate in the discharge program. At final follow-up, three patients were awaiting discharge. The complication rate in the series was similar to an earlier series of 52 patients with a pneumatic LVAD.
      
    Outpatient LVAD support is safe and offers improved quality of life for patients awaiting heart transplantation. Wearable and totally implantable LVADs should be evaluated as permanent treatment options in patients who are not candidates for heart transplantation.
        

 

By |2022-07-20T16:44:31+00:00July 20, 2022|Uncategorized|Comments Off on Cardiac Transplantation

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