title: Minimally Invasive Aortic Valve Replacement: Cost-Benefit Analysis of Ministernotomy Versus Minithoracotomy Approach.
abstract: OBJECTIVE
  Minimally invasive aortic valve replacement via ministernotomy (ministernotomy-AVR) or minithoracotomy (minithoracotomy-AVR) is gaining popularity. To date, a direct comparison of ministernotomy-AVR versus minithoracotomy-AVR is lacking. The study aim was to compare these two procedures from a cost-benefit perspective.
  
  
  METHODS
  Eight reports from the United States were selected from amongst 33,494 literature citations based on sample size and data completeness. Perioperative variables were collected for each surgical approach. Fixed and variable costs were estimated as cost per case in excess of full sternotomy AVR procedures.
  
  
  RESULTS
  Ministernotomy-AVR patients were of a significantly lower mean age (59.8 years versus 67.9 years), ejection fraction (50.4-51.6% versus 56.1-57.8%), shorter cardiopulmonary bypass time (97.2 min versus 125.6 min) and cross-clamp time (69.9 min versus 87.9 min), a lower rate of blood transfusion (25.9% versus 64.4%), and a shorter length of hospital stay (5.7 versus 6.2 days). There were no significant inter-group differences in 30-day mortality, conversion to sternotomy, neurologic events, arrhythmia, wound infection, or postoperative bleeding. Assuming a volume of 50 cases per year, the added operative cost per case for a minithoracotomy-AVR was US$ 4,254 compared to US$ 290 for a ministernotomy-AVR. The added costs per case, assuming 200 cases per year, were US$ 4,209 and US$ 290, respectively. A minithoracotomy-AVR program performing 50 cases per year adds US$ 1,063,665 of operative costs over five years, compared to US$ 72,500 for a ministernotomy-AVR program.
  
  
  CONCLUSIONS
  The present analysis suggested that the clinical benefits of ministernotomy-AVR are comparable or better than those of minithoracotomy-AVR, and at lower costs. Healthcare delivery organizations should consider the results of cost-benefit examinations when developing surgical valve replacement programs.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hassan
authors.forename: Yongjie
authors.initials: Y
authors.lastname: Miao
authors.forename: Ahmed
authors.initials: A
authors.lastname: Maraey
authors.forename: Joy
authors.initials: J
authors.lastname: Lincoln
authors.forename: Shelby
authors.initials: S
authors.lastname: Brown
authors.forename: Jimmy
authors.initials: J
authors.lastname: Windsor
authors.forename: Marco
authors.initials: M
authors.lastname: Ricci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; 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; D018803:Models, Economic; D061646:Operative Time; D017064:Process Assessment, Health Care / Q000191:economics*; D056346:Sternotomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States