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Diapositiva 1 - Gastaldi Congressi
Outcomes With Current Devices Are We Really Improving? Dip. Cardiovascolare Direttore Ettore Vitali ISHLT/MCSD Analysis, n=655 Intention to Treat n Bridge to transplant Bridge to recovery Destination Therapy Not specified 513 35 78 29 78.3% 5.3% 11.9% 4.4% Total 655 100% ISHLT 2005 J Heart Lung Transplant 2005;24:1182-1187 Dip. Cardiovascolare Direttore Ettore Vitali % of 655 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 Dip. Cardiovascolare Direttore Ettore Vitali 100 % Dip. Cardiovascolare Direttore Ettore Vitali Quality of Live Dip. Cardiovascolare Direttore Ettore Vitali Cumulative Events per 100 Patients ISHLT/MCSD Analysis 300 250 200 Infection Episodes (n=668) 150 175 100 75 Bleeding Episodes (n=396) 18 Thromboembolism Episodes (n=86) 50 0 0 1 2 3 4 5 6 7 8 9 Months after Device Implant Dip. Cardiovascolare Direttore Ettore Vitali 10 11 12 INTERMACS first DATABASE BUT: • No standardized INDICATIONS • NO consensus between different CENTERS • Different VADs Dip. Cardiovascolare Direttore Ettore Vitali Personal experience with INCOR (14 pts) 5 transplanted 4 died 1 perioperative 5 months 14 months 35 months 9 non trasplanted 4 on going 1 recovery Dip. Cardiovascolare Direttore Ettore Vitali Personal experience with INCOR • Less neurological problems (more aggressive anticoagulation protocol) • High infective risk • Good Quality of Live Dip. Cardiovascolare Direttore Ettore Vitali Indications Cultural Devices IMPROVING Dip. Cardiovascolare Direttore Ettore Vitali Dip. Cardiovascolare Direttore Ettore Vitali Dip. Cardiovascolare Direttore Ettore Vitali INDICATIONS SHORT-TERM LONG-TERM • Bridge to Recovery • Bridge to TxC • Bridge to Bridge • Destination Therapy Dip. Cardiovascolare Direttore Ettore Vitali VAD as DIALYSIS Dip. Cardiovascolare Direttore Ettore Vitali VAD as CRT Dip. Cardiovascolare Direttore Ettore Vitali CULTURAL IMPROOVEMENT Dip. Cardiovascolare Direttore Ettore Vitali Patients Is it only a prosthesis? Dip. Cardiovascolare Direttore Ettore Vitali VAD CANDIDATES 282 CHF pts 256 tx 16 No Tx 10 26 Medical therapy 3.5% Dip. Cardiovascolare Direttore Ettore Vitali VAD CANDIDATES in ITALY 129309 140000 120000 63985 pts x 3.5% = 100000 80000 2239 pts 60000 43183 40000 18661 20000 164 169 164 1644 0 <1 1 - 14 15 - 24 25 - 44 45 - 64 65 - 74 Dip. Cardiovascolare Direttore Ettore Vitali >= 75 Health providers Devices Batteries VADs had to be paid for 3-5 years Hospital Ambulatory Follow up and manteinance Dip. Cardiovascolare Direttore Ettore Vitali Who pays? today And tomorrow? Dip. Cardiovascolare Direttore Ettore Vitali The Value of Medical Spending in the United States, 1960 –2000 N Engl J Med 2006;355:920-7. Causes of Increases in Life Expectancy among Newborns, 1960–2000. Cause Increase in Life Expectancy Relative Contribution yr % Reduction in rate of death from cardiovascular disease Reduction in rate of death in infancy Reduction in rate of death from external causes Reduction in rate of death from pneumonia or influenza Reduction in rate of death from cancer 4.88 1.35 0.36 0.28 0.19 70 19 5 4 3 Total 6.97 100 Dip. Cardiovascolare Direttore Ettore Vitali