title: Clinical Outcome and Cost Analysis of Sutureless Versus Transcatheter Aortic Valve Implantation With Propensity Score Matching Analysis.
abstract: Surgical sutureless and interventional transcatheter aortic valve prostheses are nowadays extensively adopted in high-risk elderly patients. An explorative analysis was carried out to compare the clinical outcome and costs associated to these approaches. Since 2010, a total of 626 patients were distributed between transcatheter aortic valve implantation (TAVI; n = 364) and sutureless (n = 262) groups. Patients of both groups were not comparable for clinical and surgical characteristics, but many patients were in a "gray zone"; therefore, a retrospective propensity score analysis was possible and performed. For the matched pair samples, postoperative, follow-up clinical data, and costs data were obtained. In-hospital death occurred in 5 patients in sutureless group and 3 patients in TAVI group (p = 0.36). Blood transfusions were higher in sutureless group (2.1 ± 2.3 vs 0.4 ± 1.0 U). TAVI group had a shorter intensive care unit and hospital stay (2.2 ± 2.7 vs 3.2 ± 3.5 days, p = 0.037; 12 ± 6 vs 14 ± 6 days, p = 0.017). No differences in postoperative neurologic (p = 0.361), renal (p = 0.106), or respiratory (p = 0.391) complications were observed between groups. At follow-up (24.5 ± 13.8 months), 1 patient in sutureless group and 7 patients in TAVI group died (p = 0.032). Paravalvular leakage occurred more frequently in patients in TAVI group (35 [34%] vs 7 [6.9%]; p <0.001) with an impact on follow-up survival rate. The costs associated to the 2 procedures are similar when the cost of the device was excluded (p = 0.217). When included, the sutureless approach resulted a cost saving (€22,451 vs €33,877, p <0.001). In conclusion, the patients in the "gray zone" record a satisfying clinical outcome after sutureless surgery and TAVI. Patients in the sutureless group endure more hospital complications, but TAVI entails a higher follow-up mortality. On the costs aspects, TAVI technologies are more expensive, and it reflects on higher overall hospital costs.
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany. Electronic address: giuseppe.santarpino@klinikum-nuernberg.de.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Pfeiffer
authors.affiliation: Department of Cardiology, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Jessl
authors.affiliation: Department of Cardiac Surgery, University of Münster, Münster, Germany.
authors.forename: Angelo
authors.initials: A
authors.lastname: Dell'Aquila
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Vogt
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Che
authors.initials: C
authors.lastname: von Wardenburg
authors.affiliation: Department of Cardiology, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schwab
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Sirch
authors.affiliation: Department of Cardiology, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pauschinger
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000191:economics / Q000601:surgery*; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D017721:Hospital Costs; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D057216:Propensity Score; D011474:Prosthesis Design; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome