ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
John A. Kern
Curtis G. Tribble
Irving L. Kron
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cope, J. T.
Right arrow Articles by Kron, I. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cope, J. T.
Right arrow Articles by Kron, I. L.
Related Collections
Right arrow Transplantation - heart
Right arrowRelated Article

Ann Thorac Surg 2001;72:1298-1305
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

A cost comparison of heart transplantation versus alternative operations for cardiomyopathy

Jeffrey T. Cope, MDa, Aditya K. Kaza, MDa, Clifton C. Reade, BAa, Kimberly S. Shockey, MSa, John A. Kern, MDa, Curtis G. Tribble, MDa, Irving L. Kron, MDa

a Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia, USA

Accepted for publication June 11, 2001.

Address reprint requests to Dr Kron, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Box 3111, MR4 Building, University of Virginia Health Sciences Center, Charlottesville, VA 22908
e-mail: ikron{at}virginia.edu

Background. Heart transplantation is an established therapy for cardiomyopathy but is limited by organ shortage and expense. As a result, alternative operations have been proposed including coronary bypass, mitral valve repair, and left ventricular reconstruction. Because it is unknown whether alternative operations are less expensive than replacing the diseased heart, we compared in-hospital costs and early outcome of these operations with elective heart transplantation.

Methods. We compared clinical and financial data of 268 patients with ejection fraction less than 30% who underwent elective heart transplantation (n = 52, UNOS status 2 only), coronary bypass (n = 176), mitral repair (n = 15), or left ventricular reconstruction (n = 25). Data were evaluated for between-group differences, with p less than 0.05 as significant.

Results. Preoperative ejection fraction, although similar for heart transplantation (21.2% ± 1.3%), coronary bypass (25.8% ± 0.4%), mitral repair (22.9% ± 1.5%), and left ventricular reconstruction (24.2% ± 2.1%), was significantly different between the former two (p < 0.001). There was no difference in operative mortality: 5.8% (3 of 52), 3.4%(7 of 176), 6.7% (1 of 15), and 4.0% (1 of 25), respectively (p = 0.8). However, total hospital cost of heart transplantation was significantly greater than all others: $75,992 ± $5,380, $25,008 ± $1,446, $32,375 ± $2,379, and $26,584 ± $4,076, respectively (p < 0.001). Organ procurement expenses alone comprised 39.7% ($30,169) of total transplant cost. Kaplan-Meier survival analysis failed to show any survival difference between the various groups (p = 0.86)

Conclusions. Compared with heart transplantation, alternative operations yield a comparable early outcome and long-term survival, and are markedly less expensive. The cost of transplantation, which is largely due to procurement expenses, is yet another reason to attempt alternative operations for cardiomyopathy whenever feasible.


Related Article

Invited commentary
James D. Fonger
Ann. Thorac. Surg. 2001 72: 1305. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Cotrufo, L. S. De Santo, A. D. Corte, G. Romano, C. Amarelli, M. De Feo, G. Santarpino, M. Scardone, and G. Nappi
Acute hemodynamic and functional effects of surgical ventricular restoration and heart transplantation in patients with ischemic dilated cardiomyopathy.
J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1054 - 1060.
[Abstract] [Full Text] [PDF]

Home page
 Arch SurgHome page
I. L. Kron
Mixter Lecture: Changing Clinical Practice in Surgery
Arch Surg, April 1, 2005; 140(4): 368 - 370.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Cotrufo, G. Romano, L. S. De Santo, A. D. Corte, C. Amarelli, G. Cafarella, C. Maiello, and M. Scardone
Treatment of extensive ischemic cardiomyopathy: quality of life following two different surgical strategies
Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 481 - 487.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. J. DeRose Jr, I. K. Toumpoulis, S. K. Balaram, J. P. Ioannidis, S. Belsley, R. C. Ashton Jr, D. G. Swistel, and C. E. Anagnostopoulos
Preoperative prediction of long-term survival after coronary artery bypass grafting in patients with low left ventricular ejection fraction
J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 314 - 321.
[Abstract] [Full Text] [PDF]

Home page
 J Intensive Care MedHome page
R. S. Poston and B. P. Griffith
Heart Transplantation
J Intensive Care Med, January 1, 2004; 19(1): 3 - 12.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. A. Carr, B. E. Haithcock, G. Paone, A. F. Bernabei, and N. A. Silverman
Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction
Ann. Thorac. Surg., November 1, 2002; 74(5): 1531 - 1536.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2001 by The Society of Thoracic Surgeons.