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      Use of durable left ventricular assist devices for high-risk patients: Korean experience before insurance coverage

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          Abstract

          Background

          Left ventricular assist devices (LVADs) were not covered by the Korean national insurance until September 2018, and they were implanted at the patient’s own or a third party’s expense. However, there have been no reports on using an LVAD without insurance coverage or manufacturer support.

          Methods

          We reviewed 23 patients who underwent durable LVAD implantation at our institution from August 2012 to September 2018. Patients with temporary LVADs using extracorporeal or paracorporeal circulation were excluded. The available devices were the HeartMate II TM (HMII) and HeartWare TM Ventricular Assist Device (HVAD). The primary outcome was 30-day mortality. The secondary outcomes were postoperative complications and late mortality.

          Results

          The mean age of the patients was 68.7±9.9 years. The study sample comprised six female (26.1%) and 17 male (73.9%) patients. All patients had modifiable (bridge to candidacy) or unmodifiable absolute (destination therapy) contraindications for heart transplantation (HT). Among the patients in this study, 12 (52.2%) had ischemic cardiomyopathy and 11 (47.8%) had non-ischemic cardiomyopathy. Nine patients (39.1%) had temporary mechanical circulatory support such as extracorporeal membrane oxygenation or a temporary LVAD in place preoperatively. The average duration of LVAD support was 618.6±563.2 days (range, 59–2,285 days). There was no 30-day mortality. Four patients (17.4%) underwent HT. Six patients (26.1%) underwent re-exploration for postoperative bleeding, and one patient (4.3%) had a disabling stroke after discharge. The estimated survival rates at 12 and 24 months were 89.2% and 68.8%, respectively.

          Conclusions

          All patients who received LVADs before insurance coverage had contraindications for HT. The overall outcomes were comparable with those reported in the international registry.

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          Author and article information

          Journal
          J Thorac Dis
          J Thorac Dis
          JTD
          Journal of Thoracic Disease
          AME Publishing Company
          2072-1439
          2077-6624
          December 2020
          December 2020
          : 12
          : 12
          : 7236-7244
          Affiliations
          [1 ]Department of Thoracic and Cardiovascular Surgery, Hanyang University Medical Center, Hanyang University School of Medicine , Seoul, Korea;
          [2 ]Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea;
          [3 ]Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi-do, Korea;
          [4 ]Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
          Author notes

          Contributions: (I) Conception and design: JH Lee, YH Cho; (II) Administrative support: YH Cho; (III) Provision of study materials or patients: JH Lee, I Park, H Lee, YT Lee; (IV) Collection and assembly of data: JH Lee, K Sung, JH Yang, YH Cho; (V) Data analysis and interpretation: JH Lee, D Kim, JO Choi, ES Jeon; (VI) Manuscript writing: All authors; (VII) Final approval of the manuscript: All authors.

          Correspondence to: Yang Hyun Cho, MD, PhD. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Email: mdcho95@ 123456gmail.com .
          Article
          PMC7797861 PMC7797861 7797861 jtd-12-12-7236
          10.21037/jtd-20-1429
          7797861
          33447412
          2020 Journal of Thoracic Disease. All rights reserved.
          Categories
          Original Article

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