FROM THE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Outcomes were similar, but hospital costs improved with use of mini-aortic valve replacement, compared with conventional AVR, according to the results of a Society of Thoracic Surgeons (STS) database study of 1,341 patients who underwent primary AVR at 17 hospitals.
A propensity match cohort analysis was done to compare patients who had conventional (67%) vs. mini-AVR (33%) performed using either partial sternotomy or right thoracotomy.
Mortality, stroke, renal failure, atrial fibrillation, reoperation for bleeding, and respiratory insufficiency were not statistically significantly different between the two groups. There was also no significant difference in ICU or hospital length of stay between the two groups. However, mini-AVR was associated with both significantly decreased ventilator time (5 vs. 6 hours) and blood product transfusion (25% vs. 32%), according to the report, which was published online and scheduled for the April issue of the Journal of Thoracic and Cardiovascular Surgery ( doi:10.1016/j/jtcvs.2015.01.014 ).
Total hospital cost was significantly lower in the mini-AVR group ($36,348) vs. the conventional repair group ($38,239, P = .02), wrote Dr. Ravi Kiran Ghanta of the University of Virginia, Charlottesville, and his colleagues.
The authors discussed the previously raised issue of longer cross-clamp and bypass times seen in earlier studies of mini-AVR. In their current study, such was not the case, with mini-AVR appearing equivalent with conventional operations. The authors suggested that surgeons have now adopted techniques to reduce bypass and cross-clamp times with mini-AVR.
Data were limited to in-hospital costs. Other costs, such as those of rehabilitation and lost productivity, were not included in the analysis. “Including these health-care costs may have increased overall savings with mini-AVR compared to conventional AVR,” the authors noted.
“Mini-AVR is associated with decreased ventilator time, blood product utilization, early discharge, and reduced total hospital cost. In contemporary clinical practice, mini-AVR is safe and cost-effective,” the researchers concluded.
The authors reported that they had no conflicts.