title: Is a minimally invasive approach for mitral valve surgery more cost-effective than median sternotomy?
abstract: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is a minimally invasive approach for mitral valve surgery more cost-effective than median sternotomy? Altogether, 51 studies were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. No randomized controlled trials have assessed the cost-effectiveness of less invasive mitral valve surgery compared with median sternotomy, with the best evidence coming from retrospective and propensity-matched analyses. Five studies compared minithoracotomy versus sternotomy, one compared minimally invasive port-access surgery versus sternotomy and one compared video-assisted minithoracotomy versus sternotomy. The use of a minithoracotomy or a minimally invasive port-access approach for mitral valve surgery resulted in significant reductions in costs of cardiac imaging and laboratory tests, lower use of blood products, fewer perioperative infections, faster recovery, shorter hospital length of stay, fewer requirements for rehabilitation and lower readmission rates in the following postoperative year. We conclude that a minimally invasive approach for mitral valve surgery is safe, effective and significantly more cost-effective than median sternotomy.
authors.affiliation: Department of Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA osantana@msmc.com.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.affiliation: Department of Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Maiteder
authors.initials: M
authors.lastname: Larrauri-Reyes
authors.affiliation: Department of Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Zamora
authors.affiliation: Department of Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
mesh_terms: D003362:Cost-Benefit Analysis; D006349:Heart Valve Diseases / Q000191:economics / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000191:economics*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D008943:Mitral Valve / Q000601:surgery*; D056346:Sternotomy / Q000191:economics*
keywords: Cost; Median sternotomy; Minimally invasive; Mitral valve surgery; Resource utilization