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Minimally Invasive Aortic Valve Replacement Yields Reduced Hospital Resource Utilization Versus Sternotomy: A Propensity Matched Study
Ryan J. Vela1, Mary E. Huerter1, Lily Campbell2, Neelan Doolabh1, Jessica Pruszynski1.
1UT Southwestern Medical Center, Dallas, TX, USA, 2Boston University, Boston, MA, USA.
Background: We aim to analyze hospital resource utilization and discharge disposition differences between two different surgical approaches to aortic valve replacement (AVR) in a propensity-matched model. Methods: A propensity score was generated and matched pairs assigned. Quality of the match was assessed by comparing the distribution of model covariates before and after the match. Median and interquartile ranges described continuous variables; categorical variables were described using frequencies and percentages. Kruskal-Wallis test was used for continuous and ordinal categorical variable comparisons; chi square and Fisher’s exact test was used to compare nominal categorical variables. Patients with endocarditis and those whom received other simultaneous cardiac operations were excluded. A composite of post-operative complications was created consisting of surgical site infection, reoperation, stroke, pneumonia, venous thromboembolism, pneumothorax, rhythm disturbance requiring intervention, 30-day mortality, and readmission.
Results: 166 aortic valve patients were identified, 38 underwent FS and 128 MI. The post-matching pairs are summarized in Table 1. Bivariate analysis of the pairs yielded no differences in aortic valve (AV) gradient or area (FS: 47 mmHg [39.2-61], MI: 46 mmHg [38.5-61.8]; FS: 0.8 mm2 [0.6-0.9], MI: 0.8 mm2 [0.6-0.8], p > 0.05). Overall operative time was reduced in MI (FS: 258 minutes [231-309.2], MI: 173.5 minutes [159-223), p < 0.001). All intraoperative blood product transfusions were significantly reduced for MI compared to FS and postoperative transfusions were reduced for MI (p = 0.034, p = 0.025). A composite score for post-operative complications was significantly less in the MI group (FS: 15 [39%], MI: 7 [18%], p = 0.046). Total ventilator hours was reduced for MI along with ICU hours (FS: 5.2 hours [3.2-18.8], MI: 1.2 hours [0-3.8], p < 0.001; FS: 53.8 hours [44-96.5], MI: 31.9 hours [24.3-55.3], p = 0.009). Overall length of stay was reduced for MI (FS: 7 days [6-9], MI: 4 days [3.5-8], p < 0.001). Lastly, discharge home versus nursing home or rehab facility discharge was significantly improved in the MI group (p = 0.046).
Conclusions: MI approach to AVR reduces hospital resource utilization and improves discharge disposition compared to FS-AVR.
| Variable | Sternotomy (n=38) | Minimally-Invasive (n=38) |
| Age | 60.6 years (41.8-68.6) | 61.9 years (56.1-66.2) |
| COPD | 9 (24%) | 10 (26%) |
| EF | 60 (47.8-63) | 60 (55-67.2) |
| Moderate-Severe Aortic Insufficiency | 11 (29%) | 8 (21%) |
| Pulmonary Hypertension | 21 (55%) | 23 (61%) |
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