title: Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis.
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.
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors: Ravi K
authors: RK
authors: Ghanta
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors: Damien J
authors: DJ
authors: Lapar
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors: John A
authors: JA
authors: Kern
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
authors: Irving L
authors: IL
authors: Kron
authors: Cardiovascular and Thoracic Associates, Innova Heart and Vascular Institute, Falls Church, Va.
authors: Alan M
authors: AM
authors: Speir
authors: Virginia Cardiac Surgery Quality Initiative, Richmond, Va.
authors: Edwin
authors: E
authors: Fonner
authors: Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Va.
authors: Mohammed
authors: M
authors: Quader
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va. Electronic address: gorav@virginia.edu.
authors: Gorav
authors: G
authors: Ailawadi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001803:Blood Transfusion / Q000191:economics; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000379:methods* / Q000401:mortality; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012042:Registries; D012121:Respiration, Artificial / Q000191:economics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia