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.
