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Outcomes With Current Devices Are We Really Improving?. 2005. ISHLT. J Heart Lung Transplant 2005;24:1182-1187. ISHLT/MCSD Analysis, n=655. Intention to Treat n % of 655 Bridge to transplant 513 78.3% Bridge to recovery 35 5.3%

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Outcomes with current devices are we really improving

Outcomes With Current Devices Are We Really Improving?


2005

ISHLT

J Heart Lung Transplant 2005;24:1182-1187

ISHLT/MCSD Analysis, n=655

Intention to Treat n % of 655

Bridge to transplant 513 78.3%

Bridge to recovery 35 5.3%

Destination Therapy 78 11.9%

Not specified 29 4.4%

Total 655 100%


INTERMACS: March 2006 – March 2008, n = 483

Device Strategy at Implant %

Bridge to Recovery 27 5 %

Bridge to Transplant 460 80 %

Destination Therapy 90 15 %

Total 483 100 %



ISHLT/MCSD Analysis

Infection Episodes (n=668)

175

Cumulative Events per 100 Patients

Bleeding Episodes (n=396)

75

Thromboembolism Episodes (n=86)

18

Months after Device Implant


Intermacs first database but
INTERMACS first DATABASEBUT:

  • No standardized INDICATIONS

  • NO consensus between different CENTERS

  • Different VADs


Personal experience with incor 14 pts
Personal experience with INCOR(14 pts)

5 transplanted

9 non trasplanted

4 died

1 perioperative

5 months

14 months

35 months

4 on going

1 recovery


Personal experience with incor
Personal experience with INCOR

  • Less neurological problems

    (more aggressive anticoagulation protocol)

  • High infective risk

  • Good Quality of Live


Indications

Devices

Cultural

IMPROVING


INDICATIONS

SHORT-TERM LONG-TERM

  • Bridge to Recovery

  • Bridge to Bridge

  • Bridge to TxC

  • Destination Therapy



VAD as CRT


Cultural improovement
CULTURAL IMPROOVEMENT


Patients

Is it only a prosthesis?


Vad candidates

VAD CANDIDATES

282 CHF pts

tx

Medical

therapy

No Tx

3.5%


VAD CANDIDATES in ITALY

129309

140000

120000

63985 pts x 3.5% = 2239 pts

100000

80000

60000

43183

40000

18661

20000

164

169

164

1644

0

< 1

1 - 14

15 - 24

25 - 44

45 - 64

65 - 74

>= 75


Health providers

Devices

Batteries

Hospital

Ambulatory

Follow up and manteinance

VADs had to be paid for 3-5 years

Who pays?


Today
today

And tomorrow?


The value of medical spending in the united states 1960 2000 n engl j med 2006 355 920 7
The Value of Medical Spendingin the United States, 1960 –2000N Engl J Med 2006;355:920-7.

Causes of Increases in Life Expectancy among Newborns, 1960–2000.

Cause Increase in Life Relative

Expectancy Contribution

yr %

Reduction in rate of death from cardiovascular disease 4.88 70

Reduction in rate of death in infancy 1.35 19

Reduction in rate of death from external causes 0.36 5

Reduction in rate of death from pneumonia or influenza 0.28 4

Reduction in rate of death from cancer 0.19 3

Total 6.97 100


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