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Comparative Study
. 2015 Apr;149(4):1060-5.
doi: 10.1016/j.jtcvs.2015.01.014. Epub 2015 Jan 12.

Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis

Ravi K Ghanta  1 , Damien J Lapar  1 , John A Kern  1 , Irving L Kron  1 , Alan M Speir  2 , Edwin Fonner Jr  3 , Mohammed Quader  4 , Gorav Ailawadi  5
Affiliations
Comparative Study

Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis

Ravi K Ghanta et al. J Thorac Cardiovasc Surg. 2015 Apr.

Abstract

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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Conflict of interest statement

Conflicts of Interest Statement: The authors have no conflict of interest that would impact this study’s design, data collection, analysis, and interpretation.

Figures

Figure 1
Figure 1. Hospital Costs for Propensity Matched Patients
Median total hospital cost was $1,891 (p=0.02) lower in mini-AVR compared to conventional AVR.
See this image and copyright information in PMC

Comment in

  • The value of measuring value.
    DiSesa VJ. DiSesa VJ. J Thorac Cardiovasc Surg. 2015 Apr;149(4):1066. doi: 10.1016/j.jtcvs.2015.01.049. Epub 2015 Feb 7. J Thorac Cardiovasc Surg. 2015. PMID: 25749143 No abstract available.

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