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, Damien J. Lapar, John A. Kern, Irving L. Kron, Alan M. Speir, Edwin Fonner, Mohammed Quader, Gorav Ailawadi

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1060-1065
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume149
Issue number4
DOIs
StatePublished - Apr 1 2015

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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