PMID- 18722319
OWN - NLM
STAT- MEDLINE
DCOM- 20081021
LR  - 20101118
IS  - 1532-8414 (Electronic)
IS  - 1071-9164 (Linking)
VI  - 14
IP  - 7
DP  - 2008 Sep
TI  - Surgical ventricular restoration versus cardiac transplantation: a comparison of 
      cost, outcomes, and survival.
PG  - 547-54
LID - 10.1016/j.cardfail.2008.04.007 [doi]
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.
FAU - Williams, Jason A
AU  - Williams JA
AD  - Johns Hopkins Medical Institutions, Division of Cardiac Surgery, Baltimore, MD 
      21287-4618, USA.
FAU - Weiss, Eric S
AU  - Weiss ES
FAU - Patel, Nishant D
AU  - Patel ND
FAU - Nwakanma, Lois U
AU  - Nwakanma LU
FAU - Reeb, Brigitte E
AU  - Reeb BE
FAU - Conte, John V
AU  - Conte JV
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20080611
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
SB  - IM
CIN - J Card Fail. 2009 Feb;15(1):80; author reply 81. PMID: 19181299
MH  - Adult
MH  - Cardiac Output/physiology
MH  - Cohort Studies
MH  - Coronary Artery Bypass
MH  - Cost-Benefit Analysis
MH  - Costs and Cost Analysis
MH  - Drug Costs
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Transplantation/economics/statistics & numerical data
MH  - Heart Ventricles/*surgery
MH  - Hospital Charges
MH  - Humans
MH  - Length of Stay/economics/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/surgery
MH  - Myocardial Ischemia/*surgery
MH  - Renal Insufficiency/physiopathology
MH  - Retrospective Studies
MH  - Stroke Volume/physiology
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Ventricular Function, Left/physiology
EDAT- 2008/08/30 09:00
MHDA- 2008/10/22 09:00
CRDT- 2008/08/30 09:00
PHST- 2007/04/07 00:00 [received]
PHST- 2008/04/22 00:00 [revised]
PHST- 2008/04/25 00:00 [accepted]
PHST- 2008/08/30 09:00 [pubmed]
PHST- 2008/10/22 09:00 [medline]
PHST- 2008/08/30 09:00 [entrez]
AID - S1071-9164(08)00147-4 [pii]
AID - 10.1016/j.cardfail.2008.04.007 [doi]
PST - ppublish
SO  - J Card Fail. 2008 Sep;14(7):547-54. doi: 10.1016/j.cardfail.2008.04.007. Epub 
      2008 Jun 11.