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dc.contributor.authorSeco, Michael
dc.contributor.authorZhao, Dong Fang
dc.contributor.authorByrom, Michael J
dc.contributor.authorWilson, Michael K
dc.contributor.authorVallely, Michael P
dc.contributor.authorFraser, John F
dc.contributor.authorBannon, Paul G
dc.description.abstractBackground: This systematic review aimed to evaluate the clinical outcomes and cost-effectiveness of left ventricular assist devices (LVADs) used as bridge to transplantation (BTT), compared to orthotopic heart transplantation (OHT) without a bridge. Method: Systematic searches were performed in electronic databases with available data extracted from text and digitized figures. Meta-analysis of short and long-term term post-transplantation outcomes was performed with summation of cost-effectiveness analyses. Results: Twenty studies reported clinical outcomes of 4575 patients (1083 LVAD BTT and 3492 OHT). Five studies reported cost-effectiveness data on 837 patients (339 VAD BTT and 498 OHT). There was no difference in long-term post-transplantation survival (HR 1.24, 95% CI 1.00–1.54), acute rejection (HR 1.10, 95% CI 0.93–1.30), or chronic rejection and cardiac allograft vasculopathy (HR 0.99, 95% CI 0.73–1.36). No differences were found in 30-day post-operative mortality (OR 0.91, 95% CI 0.42–2.00), stroke (OR 1.64, 95% CI 0.43–6.27), renal failure (OR 1.43, 95% CI 0.58–3.54), bleeding (OR 1.56, 95% CI 0.78–3.13), or infection (OR 2.44, 95% CI 0.81–7.38). Three of the five studies demonstrated incremental cost-effectiveness ratios below the acceptable maximum threshold. The total cost of VAD BTT ranged from $316,078 to $1,025,500, and OHT ranged from $179,051 to $802,200. Conclusion: LVADs used as BTT did not significantly alter post-transplantation long-term survival, rejection, and post-operative morbidity. LVAD BTT may be cost-effective, particularly in medium and high-risk patients with expected prolonged waiting times, renal dysfunction, and young patients.
dc.relation.ispartofjournalInternational Journal of Cardiology
dc.subject.fieldofresearchCardiovascular medicine and haematology
dc.subject.keywordsScience & Technology
dc.subject.keywordsLife Sciences & Biomedicine
dc.subject.keywordsCardiac & Cardiovascular Systems
dc.subject.keywordsCardiovascular System & Cardiology
dc.subject.keywordsLeft ventricular assist device
dc.titleLong-term prognosis and cost-effectiveness of left ventricular assist device as bridge to transplantation: A systematic review
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationSeco, M; Zhao, DF; Byrom, MJ; Wilson, MK; Vallely, MP; Fraser, JF; Bannon, PG, Long-term prognosis and cost-effectiveness of left ventricular assist device as bridge to transplantation: A systematic review, International Journal of Cardiology, 2017, 235, pp. 22-32
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gro.griffith.authorFraser, John F.

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