1. Dip. Cardiovascolare Direttore Ettore Vitali Outcomes With Current Devices Are We Really Improving?

2. Dip. Cardiovascolare Direttore Ettore Vitali Intention to Treatn % of 655 Bridge to transplant513 78.3% Bridge to recovery 35 5.3% Destination Therapy 78 11.9% Not specified 29 4.4% Total655 100% ISHLT/MCSD Analysis, n=655 ISHLT 2005 J Heart Lung Transplant 2005;24:1182-1187

3. Dip. Cardiovascolare Direttore Ettore Vitali Device Strategy at Implant % Bridge to Recovery 27 5 % Bridge to Transplant 460 80 % Destination Therapy 90 15 % INTERMACS: March 2006 – March 2008, n = 483 Total 483 100 %

4. Dip. Cardiovascolare Direttore Ettore Vitali

5. Dip. Cardiovascolare Direttore Ettore Vitali Quality of Live

6. Dip. Cardiovascolare Direttore Ettore Vitali ISHLT/MCSD Analysis Cumulative Events per 100 Patients Months after Device Implant Bleeding Episodes (n=396) Infection Episodes (n=668) Thromboembolism Episodes (n=86) 75 175 18

7. Dip. Cardiovascolare Direttore Ettore Vitali INTERMACS first DATABASE BUT: No standardized INDICATIONS NO consensus between different CENTERS Different VADs

8. Dip. Cardiovascolare Direttore Ettore Vitali Personal experience with INCOR (14 pts) 5 transplanted 9 non trasplanted 4 died 1 perioperative 5 months 14 months 35 months 4 on going 1 recovery

9. Dip. Cardiovascolare Direttore Ettore Vitali Personal experience with INCOR Less neurological problems (more aggressive anticoagulation protocol) High infective risk Good Quality of Live

10. Dip. Cardiovascolare Direttore Ettore Vitali Devices Cultural Indications IMPROVING

11. Dip. Cardiovascolare Direttore Ettore Vitali

12. Dip. Cardiovascolare Direttore Ettore Vitali

13. Dip. Cardiovascolare Direttore Ettore Vitali SHORT-TERM LONG-TERM Bridge to Recovery Bridge to Recovery Bridge to Bridge Bridge to Bridge Bridge to TxC Bridge to TxC Destination Therapy Destination Therapy INDICATIONS

14. Dip. Cardiovascolare Direttore Ettore Vitali VAD as DIALYSIS

15. Dip. Cardiovascolare Direttore Ettore Vitali VAD as CRT

16. Dip. Cardiovascolare Direttore Ettore Vitali CULTURAL IMPROOVEMENT

17. Dip. Cardiovascolare Direttore Ettore Vitali Patients Is it only a prosthesis?

18. Dip. Cardiovascolare Direttore Ettore Vitali VAD CANDIDATES Medicaltherapy 3.5% 282 CHF pts tx No Tx

19. Dip. Cardiovascolare Direttore Ettore Vitali VAD CANDIDATES in ITALY 1641691641644 18661 43183 129309 0 20000 40000 60000 80000 100000 120000 140000 < 11 - 1415 - 2425 - 4445 - 6465 - 74>= 75 63985 pts x 3.5% = 2239 pts

20. Dip. Cardiovascolare Direttore Ettore Vitali Health providers Devices Batteries Hospital Ambulatory Follow up and manteinance VADs had to be paid for 3-5 years Who pays?

21. Dip. Cardiovascolare Direttore Ettore Vitali today And tomorrow?

22. Dip. Cardiovascolare Direttore Ettore Vitali The Value of Medical Spending in the United States, 1960 –2000 N Engl J Med 2006;355:920-7. Causes of Increases in Life Expectancy among Newborns, 1960–2000. Cause Increase in Life Relative Expectancy Contribution yr % Reduction in rate of death from cardiovascular disease 4.88 70 Reduction in rate of death in infancy 1.35 19 Reduction in rate of death from external causes 0.36 5 Reduction in rate of death from pneumonia or influenza 0.28 4 Reduction in rate of death from cancer 0.19 3 Total 6.97 100