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

被引:71
作者
Ghanta, Ravi K. [1 ]
Lapar, Damien J. [1 ]
Kern, John A. [1 ]
Kron, Irving L. [1 ]
Speir, Alan M. [2 ]
Fonner, Edwin, Jr. [3 ]
Quader, Mohammed [4 ]
Ailawadi, Gorav [1 ]
机构
[1] Univ Virginia, Dept Surg, Div Thorac & Cardiovasc Surg, Charlottesville, VA 22908 USA
[2] Innova Heart & Vasc Inst, Cardiovasc & Thorac Associates, Falls Church, VA USA
[3] Virginia Cardiac Surg Qual Initiat, Richmond, VA USA
[4] Virginia Commonwealth Univ, Dept Surg, Div Cardiothorac Surg, Richmond, VA USA
关键词
CARDIAC-SURGERY; STERNOTOMY; MINISTERNOTOMY; TRANSFUSION;
D O I
10.1016/j.jtcvs.2015.01.014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:1060 / 1065
页数:6
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