Ventricular Assist Devices at What Cost? Part I
As a cardiac transplantation and ventricular assist device fellow I should be excited at the prospect of a new case of either type of surgery. For the moment, I can accept that transplantation is a good option for end-stage heart failure. However, I find myself questioning the wisdom of VADs as they exist today and in the foreseeable future.
I would point out that if the supply of donor organs were not limited there would be a dramatic decline in the need for VADs. And yet, there would still be those who would doggedly pursue what has been a holy grail in cardiac surgery: reliable and durable mechanical replacement of the human heart. I do not oppose such a goal, but I must question the application at the present time of what can only be described as mediocre technologies, with significant costs to the patient and society. Should we wait for the development of adequate technology supported by proper governmental funding?
Waiting has been problematic. Decades ago there was a stated US governmental objective to develop a mechanical heart replacement. However, this was not followed by sufficient funding for such a laudable goal. Instead, it has been left to the commercial sector to develop VADs under governmental oversight. These two facts have limited, and perhaps even impaired, the development of a reliable and durable pump. If computers would have evolved at this pace, we would still be using Commodore 64s. Hooray for the free enterprise system.
But why has the money not been put up by wealthy governments, like the US. I don't know. What I do know is that health providers and officials are lamenting the "epidemic" of heart failure in the US and other nations. Perhaps this has not been enough of an incentive to invest. So we are left with the pumps available to us today.
And what does this mean to the patient? It means highly invasive surgical procedures, bleeding, infections, strokes, re-opertions, pump failures, and limited survival measured in months. And all at a significant financial cost to the patient and society. This is of particular relevance to a public health care system such at it is in Canada.
I would point out that if the supply of donor organs were not limited there would be a dramatic decline in the need for VADs. And yet, there would still be those who would doggedly pursue what has been a holy grail in cardiac surgery: reliable and durable mechanical replacement of the human heart. I do not oppose such a goal, but I must question the application at the present time of what can only be described as mediocre technologies, with significant costs to the patient and society. Should we wait for the development of adequate technology supported by proper governmental funding?
Waiting has been problematic. Decades ago there was a stated US governmental objective to develop a mechanical heart replacement. However, this was not followed by sufficient funding for such a laudable goal. Instead, it has been left to the commercial sector to develop VADs under governmental oversight. These two facts have limited, and perhaps even impaired, the development of a reliable and durable pump. If computers would have evolved at this pace, we would still be using Commodore 64s. Hooray for the free enterprise system.
But why has the money not been put up by wealthy governments, like the US. I don't know. What I do know is that health providers and officials are lamenting the "epidemic" of heart failure in the US and other nations. Perhaps this has not been enough of an incentive to invest. So we are left with the pumps available to us today.
And what does this mean to the patient? It means highly invasive surgical procedures, bleeding, infections, strokes, re-opertions, pump failures, and limited survival measured in months. And all at a significant financial cost to the patient and society. This is of particular relevance to a public health care system such at it is in Canada.
posted by Luis G. Quiñonez, M.D. at
11:10 PM
1 Comments:
I think you have emphasized a lack of funding as the problem. My understanding is that it is unrealistic goals for a mechanical device that have hampered the available devices.
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