Effects of left ventricular assist devices on outcomes in patients undergoing heart transplantation

Background. Left ventricular assist devices (LVADs) are increasingly being used to "bridge" patients to heart transplantation. Methods. Data from 40 consecutive status 1 heart transplantation patients t reated with intravenous inotrope therapy (n = 20) or the HeartMate LVAD (n = 20) were retrospectively analyzed. Results. Baseline clinical characteristics were similar in the two groups. At the time of transplantation, LVAD patients had significantly higher bloo d pressure and sodium with significantly lower blood urea nitrogen and crea tinine. After transplantation, renal failure (52.6% versus 16.7%) and right heart failure (31.6% versus 5.6%) occurred more frequently (p < 0.05) in t he inotrope group. Six-month survival after transplantation did not signifi cantly differ in the inotrope or LVAD groups (73.7% versus 88.9%) but event -free survival was significantly (p < 0.05) lower in the inotrope group (15 .8% versus 55.6%). Total hospital charges were significantly lower in the i notrope group ($213,860 +/- $107,560 versus $342,620 +/- $104,420), but ave rage daily hospital charges were not different ($3,990 +/- $1,300 versus $4 ,130 +/- $2,050). Conclusions. Status 1 heart transplant patients treated with an LVAD as opp osed to inotrope therapy have improved clinical and metabolic function at t he time of transplant and improved survival to 6 months after transplant wi thout major complications. Total costs are higher in the LVAD patients but average daily costs are similar. (C) 2000 by The Society of Thoracic Surgeons.