ABSTRACT
BACKGROUND: Mechanical circulatory support (MCS) is an option for the treatment of medically intractable end-stage heart failure. MCS therapy, however, is resource intensive. OBJECTIVE: The purpose of this report was to systematically review the MCS cost-effectiveness literature as it pertains to the treatment of adult patients in end-stage heart failure. METHODS: We conducted a systematic search and narrative review of available cost- effectiveness and cost-utility analyses of MCS in adult patients with end-stage heart failure. RESULTS: Eleven studies analyzing the cost-effectiveness or cost-utility of MCS were identified. Seven studies focused on bridge to transplantation, three studies focused on destination therapy, and one study presented analyses of both strategies. Two articles evaluated the cost-effectiveness of the HeartMate II (Thoratec Corp., Pleasanton, CA). Incremental cost-effectiveness ratios between MCS and medical management ranged between $85,025 and $200,166 for bridge to transplantation and between $87,622 and $1,257,946 for destination therapy (2012 Canadian dollars per quality-adjusted life-year). Sensitivity analyses indicated that improvements in survival and quality of life and reductions in device and initial hospital-stay costs may improve the cost-effectiveness of MCS. CONCLUSIONS: Current studies suggest that MCS is likely not cost-effective with reference to generally accepted or explicitly stated thresholds. Refined patient selection, complication rates, achieved quality of life, and device/surgical costs, however, could modify the cost-effectiveness of MCS.
Subject(s)
Heart Failure/economics , Heart-Assist Devices/economics , Cost-Benefit Analysis , Heart Failure/therapy , Heart Transplantation , Humans , Quality of Life , Quality-Adjusted Life Years , Technology Assessment, BiomedicalABSTRACT
Double aortic arch is a congenital anomaly that rarely presents in adults. We describe the case of a 69-year-old male who presented with a double aortic arch, right arch dominant, left arch patent, experiencing progressive dysphagia since childhood.
Subject(s)
Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Deglutition Disorders/etiology , Vascular Surgical Procedures/methods , Aged , Aorta, Thoracic/diagnostic imaging , Disease Progression , Humans , Imaging, Three-Dimensional , Male , Tomography, X-Ray Computed , Vascular Calcification/diagnostic imaging , Vascular Calcification/etiology , Vascular Calcification/surgeryABSTRACT
Destination therapy with the HeartMate II left-ventricular assist device (Thoratec Corp, Pleasanton, CA) was undertaken in an adult patient with Down syndrome and end-stage heart failure. The patient was bridged to the HeartMate II with extracorporeal membrane oxygenation followed by the Levitronix CentriMag (Levitronix, Waltham, MA). HeartMate II implantation was complicated by coagulopathy. The patient spent 44 postoperative days in hospital and is currently stable in the community. No infections were acquired. Compliance training was delivered primarily to the patient's family. Destination therapy with the HeartMate II may be successfully implemented in eligible, socially supported Down syndrome patients.
