The logistics and cost-effectiveness of circulatory support: Advantages ofthe ABIOMED BVS 5000

Background. In 1994 the ABIOMED BVS 5000 was incorporated into our acute ca rdiac assist armamentarium. This report is a general overview of our experi ence. A hypothetical cost analysis focusing on specific devices and device- related personnel contrasted the BVS 5000 with our prior model of centrifug al pump use. Methods. In 3 years, 22 patients were supported with the BVS 5000, as a biv entricular assist device in 40%, right ventricular assist device in 27%, an d left ventricular assist device in 32%. Indications were postcardiotomy su pport in 12, acute myocarditis in 2, bridge to transplant in 4, and failed heart transplant in 4. The cost analysis was performed retrospectively. The actual cost of disposable blood pumps, including replacement pumps, and ca nnulae constituted the BVS cost. The hypothetical centrifugal costs include d the disposables, replacement cones, as well as the labor costs of the con tinuous perfusionist coverage. Results. Of the 22 patients, 10 (45%) were weaned and 13 (59%) were success fully discharged. Five patients were transplanted while on BVS 5000 support , accounting for a higher rate of discharge. Comparison of "actual" BVS cos ts with "projected" centrifugal costs revealed differences based upon the i ntended application of the BVS. In bridge-to-transplant patients with long duration of support, the daily cost of support was dramatically lower with the BVS 5000. For short-term postcardiotomy support, acute myocarditis, or failed transplant, the differences were small. Conclusions. Because the BVS 5000 was readily managed by the intensive care unit nursing staff, this system displaced centrifugal systems in our progr am. Outcome measures of weaning and successful discharge were improved rela tive to our prior experience with centrifugal pumps. Even without taking in direct costs into account, the hypothetical cost analysis supported continu ed use of the BVS system for acute cardiac assistance. (C) 1999 by The Soci ety of Thoracic Surgeons.