Patient Outcomes, Cost, and Length of Stay Associated With Biventricular
Assist Devices in the United States (2009-2015)
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.