Couper G S, Dekkers R J, Adams D H
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 1999 Aug;68(2):646-9. doi: 10.1016/s0003-4975(99)00584-6.
In 1994, the ABIOMED BVS 5000 was incorporated into our acute cardiac assist armamentarium. This report is a general overview of our experience. A hypothetical cost analysis focusing on specific devices and device-related personnel contrasted the BVS 5000 with our prior model of centrifugal pump use.
In 3 years, 22 patients were supported with the BVS 5000, as a biventricular assist device in 40%, right ventricular assist device in 27%, and left ventricular assist device in 32%. Indications were postcardiotomy support in 12, acute myocarditis in 2, bridge to transplant in 4, and failed heart transplant in 4. The cost analysis was performed retrospectively. The actual cost of disposable blood pumps, including replacement pumps, and cannulae constituted the BVS cost. The hypothetical centrifugal costs included the disposables, replacement cones, as well as the labor costs of the continuous perfusionist coverage.
Of the 22 patients, 10 (45%) were weaned and 13 (59%) were successfully discharged. Five patients were transplanted while on BVS 5000 support, accounting for a higher rate of discharge. Comparison of "actual" BVS costs with "projected" centrifugal costs revealed differences based upon the intended application of the BVS. In bridge-to-transplant patients with long duration of support, the daily cost of support was dramatically lower with the BVS 5000. For short-term postcardiotomy support, acute myocarditis, or failed transplant, the differences were small.
Because the BVS 5000 was readily managed by the intensive care unit nursing staff, this system displaced centrifugal systems in our program. Outcome measures of weaning and successful discharge were improved relative to our prior experience with centrifugal pumps. Even without taking indirect costs into account, the hypothetical cost analysis supported continued use of the BVS system for acute cardiac assistance.
1994年，ABIOMED BVS 5000被纳入我们的急性心脏辅助设备库。本报告是对我们经验的总体概述。一项针对特定设备及与设备相关人员的假设成本分析，将BVS 5000与我们之前使用的离心泵模型进行了对比。
在3年时间里，22例患者接受了BVS 5000的支持，其中40%作为双心室辅助设备，27%作为右心室辅助设备，32%作为左心室辅助设备。适应证包括心脏术后支持12例、急性心肌炎2例、过渡到移植4例以及心脏移植失败4例。成本分析采用回顾性方法。一次性血泵（包括备用泵）和插管的实际成本构成了BVS的成本。假设的离心泵成本包括一次性用品、备用锥以及持续灌注师覆盖的劳动力成本。
22例患者中，10例（45%）成功撤机，13例（59%）成功出院。5例患者在BVS 5000支持下接受了移植，出院率更高。将BVS的“实际”成本与离心泵的“预计”成本进行比较，结果显示基于BVS的预期应用存在差异。在需要长期支持的过渡到移植患者中，BVS 5000的每日支持成本显著更低。对于短期心脏术后支持、急性心肌炎或移植失败患者，差异较小。
由于重症监护病房护理人员能够轻松管理BVS 5000，该系统在我们的项目中取代了离心泵系统。与我们之前使用离心泵的经验相比，撤机和成功出院的结局指标有所改善。即使不考虑间接成本，假设成本分析也支持继续使用BVS系统进行急性心脏辅助。
