Cost Analysis And Clinical Outcomes Of Minimally Invasive Versus Conventional Full Sternotomy Aortic Valve Replacement
Lauren A. Salgueiro, Marlena E. Sebatino, Alexis K. Okoh, Joshua Chao, Jigesh Baxi, Fady Soliman, Cassandra Soto, Hirohisa Ikegami, Anthony Lemaire, Mark J. Russo, Leonard Y. Lee
Robert Wood Johnson University Hospital, Department of Surgery, Division of Cardiothoracic Surgery; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
Background: Minimally invasive aortic valve replacement (mini AVR) has been demonstrated to be a safe and effective treatment and is associated with significant clinical benefits compared to conventional full sternotomy AVR (CS AVR). The purpose of this study is to evaluate the cost effectiveness and outcomes of mini AVR versus CS AVR. Methods: We conducted a single center retrospective review of patients who underwent isolated surgical aortic valve replacement between March 2012 and March 2018. Patients were stratified into two groups (i) CS AVR or (ii) mini AVR and retrospectively reviewed from a prospectively maintained database. In-hospital billing data were matched with clinical outcomes data. Demographics, intra-operative and post-operative outcomes were compared. A 1:1 greedy matching technique with propensity scoring was used to match baseline characteristics between patient groups. The primary outcome was total direct costs associated with each of the two procedural approaches. Results: 754 patients had AVR via (i) CS (n=147) or (ii) mini-AVR (n=607). Mean bypass (124 vs. 92 mins; p<0.001) and clamp times (95 vs 67 mins; p<0.001) were longer in the CS AVR than the mini AVR group. Intra-operatively, CS AVR patients required more blood products (FFP, PRBC and PLT) than patients undergoing mini AVR. Post-operative LOS in the ICU (55 vs 39 hrs.; p=0.036) and overall (8 vs. 6 days; p=0.009) was longer for CS AVR patients than mini AVR patients. Total direct costs were higher in the CS AVR group than the mini AVR group. ($36,528 vs. $31,089; p=0.012). 1:1 matching resulted in 110 patients in each group with similar baseline characteristics. Among the matched cohort, CS AVR patients experienced prolonged post-operative LOS (7 vs 6 days; p=0.028) and higher direct procedure costs ($36,405 vs. $28,705, p=0.0012) Conclusions: Minimally invasive aortic valve replacement is a cost-effective treatment associated with significant clinical benefits. Furthermore, mini AVR is associated with reduced direct costs and post-operative length of stay when compared with conventional full sternotomy AVR.
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