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Patient Outcomes, Cost, and Length of Stay Associated With Biventricular Assist Devices in the United States (2009-2015)
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  • Hyeon Ju Ali,
  • Afshin Ehsan,
  • Kevin Kennedy,
  • Peter Riley,
  • Angie Seo,
  • Navkaranbir Bajaj,
  • Amitoj Singh,
  • Daniel Levine,
  • Michael Kiernan,
  • Frank Sellke,
  • Rayan Yousefzai
Hyeon Ju Ali
Houston Methodist Hospital
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Afshin Ehsan
Brown University Warren Alpert Medical School
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Kevin Kennedy
Saint Luke's Mid America Heart Institute
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Peter Riley
University of Maryland Medical System
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Angie Seo
Brown University Warren Alpert Medical School
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Navkaranbir Bajaj
The University of Alabama System
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Amitoj Singh
The University of Arizona College of Medicine Tucson
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Daniel Levine
Brown University Warren Alpert Medical School
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Michael Kiernan
Tufts Med Ctr
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Frank Sellke
Brown University Warren Alpert Medical School
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Rayan Yousefzai
Houston Methodist Hospital
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Abstract

Objectives: With recent advances in left ventricular assist device (LVAD) technology, the utilization of LVADs has increased while mortality, cost, and length of stay (LOS) have significantly decreased. This study sought to determine the national trends of surgically implanted biventricular assist devices (BiVADs). Methods: This is a retrospective analysis of the National Inpatient Sample (NIS) database for internal BiVADs (n = 538) and external BiVADs (n = 727) from 2009 to 2015. Results: Utilization of all surgically implanted BiVADs decreased (4.8% per year, p < 0.001), and was driven by a decline in utilization of external BiVADs (9.4% per year, p < 0.001). There was no significant change in BiVAD-associated mortality. However, cost and LOS increased significantly, and these trends were isolated to patients who died during their hospitalization. Patients with internal BiVADs incurred higher cost than external BiVAD patients but were more likely to survive. Conclusions: The decline in surgically implanted BiVAD utilization may be due to an improvement in LVAD technology as well as an increase in the availability of percutaneous temporary circulatory support. Future prospective studies are needed to compare various BiVAD configuration strategies and to optimize BiVAD patient selection and perioperative care.

Peer review status:IN REVISION

03 May 2021Submitted to Journal of Cardiac Surgery
18 May 2021Assigned to Editor
18 May 2021Submission Checks Completed
29 May 2021Review(s) Completed, Editorial Evaluation Pending
29 May 2021Editorial Decision: Revise Major