Surgical Ventricular Restoration Versus Cardiac Transplantation: A Comparison of Cost, Outcomes, and Survival

Jason A. Williams, Eric S. Weiss, Nishant D. Patel, Lois U. Nwakanma, Brigitte E. Reeb, John Conte

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Cardiac transplantation is the accepted standard treatment for end-stage heart disease but is donor limited. Surgical ventricular remodeling is an established treatment for patients with ischemic cardiomyopathy. We sought to compare charges, outcomes, and survival in patients undergoing surgical ventricular restoration (SVR) versus cardiac transplantation (CTx). Methods and Results: We retrospectively analyzed hospital charges, length of stay (LOS), and survival for 69 SVR and 53 CTx patients at our institution between January 2002 and June 2005. We also compared New York Heart Association (NYHA) status and Kaplan-Meier survival of our SVR patients with CTx patients with ischemic cardiomyopathy from the International Society of Heart & Lung Transplantation (ISHLT) registry. Median total LOS (12 days vs. 17 days, P = .01) and median postoperative LOS (10 days vs. 15 days, P = .02) were shorter for SVR patients than our CTx patients. Median total hospital charges ($45,506 vs. $137,679, P < .0001) and median total drug charges ($2,625 vs. $15,930, P < .0001) were lower for SVR patients. Significant improvements in ejection fraction were seen after both SVR (27% vs. 37%; P < .0001) and CTx (14% vs. 62%, P < .0001). Furthermore, 91% (49/54) of surviving SVR patients, 98% (44/45) of surviving CTx patients, and 91% of ISHLT CTx patients improved to NYHA Class I/II at follow-up. Survival did not differ between groups. Conclusions: SVR patients demonstrate cost-effective clinical improvements that lead to good overall survival. SVR is an excellent surgical option for CHF patients who are not transplant candidates, and should be considered for ischemic cardiomyopathy patients who qualify for transplantation. This strategy may help relieve donor shortage and improve allocation of donor organs.

Original languageEnglish (US)
Pages (from-to)547-554
Number of pages8
JournalJournal of Cardiac Failure
Volume14
Issue number7
DOIs
StatePublished - Sep 1 2008

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Heart Transplantation
Costs and Cost Analysis
Survival
Cardiomyopathies
Hospital Charges
Length of Stay
Tissue Donors
Ventricular Remodeling
Lung Transplantation
Registries
Heart Diseases
Transplantation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Williams, Jason A. ; Weiss, Eric S. ; Patel, Nishant D. ; Nwakanma, Lois U. ; Reeb, Brigitte E. ; Conte, John. / Surgical Ventricular Restoration Versus Cardiac Transplantation : A Comparison of Cost, Outcomes, and Survival. In: Journal of Cardiac Failure. 2008 ; Vol. 14, No. 7. pp. 547-554.
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abstract = "Background: Cardiac transplantation is the accepted standard treatment for end-stage heart disease but is donor limited. Surgical ventricular remodeling is an established treatment for patients with ischemic cardiomyopathy. We sought to compare charges, outcomes, and survival in patients undergoing surgical ventricular restoration (SVR) versus cardiac transplantation (CTx). Methods and Results: We retrospectively analyzed hospital charges, length of stay (LOS), and survival for 69 SVR and 53 CTx patients at our institution between January 2002 and June 2005. We also compared New York Heart Association (NYHA) status and Kaplan-Meier survival of our SVR patients with CTx patients with ischemic cardiomyopathy from the International Society of Heart & Lung Transplantation (ISHLT) registry. Median total LOS (12 days vs. 17 days, P = .01) and median postoperative LOS (10 days vs. 15 days, P = .02) were shorter for SVR patients than our CTx patients. Median total hospital charges ($45,506 vs. $137,679, P < .0001) and median total drug charges ($2,625 vs. $15,930, P < .0001) were lower for SVR patients. Significant improvements in ejection fraction were seen after both SVR (27{\%} vs. 37{\%}; P < .0001) and CTx (14{\%} vs. 62{\%}, P < .0001). Furthermore, 91{\%} (49/54) of surviving SVR patients, 98{\%} (44/45) of surviving CTx patients, and 91{\%} of ISHLT CTx patients improved to NYHA Class I/II at follow-up. Survival did not differ between groups. Conclusions: SVR patients demonstrate cost-effective clinical improvements that lead to good overall survival. SVR is an excellent surgical option for CHF patients who are not transplant candidates, and should be considered for ischemic cardiomyopathy patients who qualify for transplantation. This strategy may help relieve donor shortage and improve allocation of donor organs.",
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Surgical Ventricular Restoration Versus Cardiac Transplantation : A Comparison of Cost, Outcomes, and Survival. / Williams, Jason A.; Weiss, Eric S.; Patel, Nishant D.; Nwakanma, Lois U.; Reeb, Brigitte E.; Conte, John.

In: Journal of Cardiac Failure, Vol. 14, No. 7, 01.09.2008, p. 547-554.

Research output: Contribution to journalArticle

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AU - Reeb, Brigitte E.

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AB - Background: Cardiac transplantation is the accepted standard treatment for end-stage heart disease but is donor limited. Surgical ventricular remodeling is an established treatment for patients with ischemic cardiomyopathy. We sought to compare charges, outcomes, and survival in patients undergoing surgical ventricular restoration (SVR) versus cardiac transplantation (CTx). Methods and Results: We retrospectively analyzed hospital charges, length of stay (LOS), and survival for 69 SVR and 53 CTx patients at our institution between January 2002 and June 2005. We also compared New York Heart Association (NYHA) status and Kaplan-Meier survival of our SVR patients with CTx patients with ischemic cardiomyopathy from the International Society of Heart & Lung Transplantation (ISHLT) registry. Median total LOS (12 days vs. 17 days, P = .01) and median postoperative LOS (10 days vs. 15 days, P = .02) were shorter for SVR patients than our CTx patients. Median total hospital charges ($45,506 vs. $137,679, P < .0001) and median total drug charges ($2,625 vs. $15,930, P < .0001) were lower for SVR patients. Significant improvements in ejection fraction were seen after both SVR (27% vs. 37%; P < .0001) and CTx (14% vs. 62%, P < .0001). Furthermore, 91% (49/54) of surviving SVR patients, 98% (44/45) of surviving CTx patients, and 91% of ISHLT CTx patients improved to NYHA Class I/II at follow-up. Survival did not differ between groups. Conclusions: SVR patients demonstrate cost-effective clinical improvements that lead to good overall survival. SVR is an excellent surgical option for CHF patients who are not transplant candidates, and should be considered for ischemic cardiomyopathy patients who qualify for transplantation. This strategy may help relieve donor shortage and improve allocation of donor organs.

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