TY - JOUR
T1 - Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement
T2 - A real-world multi-institutional analysis
AU - Ghanta, Ravi K.
AU - Lapar, Damien J.
AU - Kern, John A.
AU - Kron, Irving L.
AU - Speir, Alan M.
AU - Fonner, Edwin
AU - Quader, Mohammed
AU - Ailawadi, Gorav
N1 - Publisher Copyright:
© 2015 The American Association for Thoracic Surgery.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Background Several single-center studies have reported excellent outcomes with minimally invasive aortic valve replacement (mini-AVR). Although criticized as requiring more operative time and complexity, mini-AVR is increasingly performed. We compared contemporary outcomes and cost of mini-AVR versus conventional AVR in a multi-institutional regional cohort. We hypothesized that mini-AVR provides equivalent outcomes to conventional AVR without increased cost. Methods Patient records for primary isolated AVR (2011-2013) were extracted from a regional, multi-institutional Society of Thoracic Surgeons database and stratified by conventional versus mini-AVR, performed by either partial sternotomy or right thoracotomy. To compare similar patients, a 1:1 propensity-matched cohort was performed after adjusting for surgeon; operative year; and Society of Thoracic Surgeons risk score, including age and risk factors (n = 289 in each group). Differences in outcomes and cost were analyzed. Results A total of 1341 patients underwent primary isolated AVR, of which 442 (33%) underwent mini-AVR at 17 hospitals. Mortality, stroke, renal failure, and other major complications were equivalent between groups. Mini-AVR was associated with decreased ventilator time (5 vs 6 hours; P =.04) and decreased blood product transfusion (25% vs 32%; P =.04). A greater percentage of mini-AVR patients were discharged within 4 days of the operation (15.2% vs 4.8%; P <.001). Consequently, total hospital costs were lower in the mini-AVR group ($36,348 vs $38,239; P =.02). Conclusions Mortality and morbidity outcomes of mini-AVR are equivalent to conventional AVR. Mini-AVR is associated with decreased ventilator time, blood product use, early discharge, and reduced total hospital cost. In contemporary clinical practice, mini-AVR is safe and cost-effective.
AB - Background Several single-center studies have reported excellent outcomes with minimally invasive aortic valve replacement (mini-AVR). Although criticized as requiring more operative time and complexity, mini-AVR is increasingly performed. We compared contemporary outcomes and cost of mini-AVR versus conventional AVR in a multi-institutional regional cohort. We hypothesized that mini-AVR provides equivalent outcomes to conventional AVR without increased cost. Methods Patient records for primary isolated AVR (2011-2013) were extracted from a regional, multi-institutional Society of Thoracic Surgeons database and stratified by conventional versus mini-AVR, performed by either partial sternotomy or right thoracotomy. To compare similar patients, a 1:1 propensity-matched cohort was performed after adjusting for surgeon; operative year; and Society of Thoracic Surgeons risk score, including age and risk factors (n = 289 in each group). Differences in outcomes and cost were analyzed. Results A total of 1341 patients underwent primary isolated AVR, of which 442 (33%) underwent mini-AVR at 17 hospitals. Mortality, stroke, renal failure, and other major complications were equivalent between groups. Mini-AVR was associated with decreased ventilator time (5 vs 6 hours; P =.04) and decreased blood product transfusion (25% vs 32%; P =.04). A greater percentage of mini-AVR patients were discharged within 4 days of the operation (15.2% vs 4.8%; P <.001). Consequently, total hospital costs were lower in the mini-AVR group ($36,348 vs $38,239; P =.02). Conclusions Mortality and morbidity outcomes of mini-AVR are equivalent to conventional AVR. Mini-AVR is associated with decreased ventilator time, blood product use, early discharge, and reduced total hospital cost. In contemporary clinical practice, mini-AVR is safe and cost-effective.
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U2 - 10.1016/j.jtcvs.2015.01.014
DO - 10.1016/j.jtcvs.2015.01.014
M3 - Article
C2 - 25680751
AN - SCOPUS:84928211685
SN - 0022-5223
VL - 149
SP - 1060
EP - 1065
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -