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PURPOSE: There are conflicting data related to the use of implantable cardioverter-defibrillators (ICDs) in patients supported with continuous-flow ventricular assist devices (LVADs). Several US studies have shown a neutral effect on mortality, whereas a recent European study suggested better outcomes in LVAD patients who have an ICD. We aimed to investigate the benefit of ICDs in patients bridged to transplant with a LVAD in the TRans-Atlantic registry on VAd and TrAnsplant (TRAViATA). METHODS: Data from consecutive patients that received a LVAD as a bridge to transplantation between January 2008 and April 2017 were collected in 7 EU (n=299) and 3 US centers (n=225). Survival analysis was performed using Kaplan-Meier and Cox proportion hazard regression analysis. Patients were censored at time of transplantation. RESULTS: Patients with an ICD at the time of LVAD (n=350) implantation were older (56 vs. 53 years, p

Purpose Left ventricular assist devices (LVAD) are widely used as bridging therapy for patients waiting heart transplantation (HTX) and as destination therapy (DT). Less is known about the global costs associated with this therapy as compared to HTX. Methods and Materials The one-year cost of treatment (starting May 2009) was analyzed for 3 consecutive groups of patients: a) 19 HTX, b) 13 LVADs for bridging and c) 6 DT patients (BENEMACS study). The total medical cost was defined as the sum of the costs of initial hospitalization, ambulatory follow-up, re-hospitalization, all retrieved from the hospital invoices and medication, calculated from the medical prescriptions. Results One-year survival was 84%, 77% and 83% for HTX, bridging and DT respectively. The initial hospitalization cost is comparable for the 3 groups. Both the monthly follow-up and the medication costs are significantly higher for the HTX patients. The total one-year cost is higher for bridging (€125108±32399) and DT (€137068±29007) therapy than for HTX (€85531±19823) due to the device cost involved. The medical decision to transplant includes the commitment to bridge (in our series 42%), leading to a one-year HTX cost of €138076±19823. The cost for the following years was estimated assuming unchanged follow-up cost. DT patients living 5 years would consume averagely €47487 per year ( figure ). Conclusions The cost of the device exceeds the medical cost involved with destination therapy. The most cost efficient therapy is transplantation only (without bridging). The total cost of destination therapy is comparable with the total cost of transplantation. The cost per year diminishes importantly the longer the patient lives.