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Cost implications of mitral valve replacement versus repair in mitral regurgitation
C W Barlow1, C J Imber, L D Sharples
1Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
Background:
Mitral valve repair and replacement (MVR) with preservation of the tendinous chordae [MVR(p)], may have better results than MVR with valve excision [MVR(e)]. It is not known whether the type of surgery affects in-hospital stay and cost.
Methods And Results:
We reviewed all patients who had mitral valve surgery for regurgitation over 5 years from January 1991. Patients were considered in three groups; MVR(e), MVR(p), and Repair. Cost was calculated using operating room, intensive care unit, and ward expenses, not hospital charges. There were a total of 253 patients; 84 MVR(e), 42 MVR(p), and 127 Repair. Mean ages and preoperative New York Heart Association (NYHA) classes were similar in the three groups. There were more male patients in the Repair (62%) and MVR(p) (67%) groups than in the MVR(e) (44%) group (P<.05), and more patients with degenerative etiology in the Repair group (P<.01). A majority of MVR(e) were in atrial fibrillation (63%), while 59% of Repair were in sinus rhythm (P<.01). Of 9 patients who died in the hospital; four had MVR(e), 3 had MVR(p), and 2 had Repair. In univariate analyses, in-hospital stay increased with patient age >70 years (P<.01), preoperative atrial fibrillation (P<.05), and NYHA class III or IV (P<.01). The median and interquartile ranges for postoperative stay was 10 (8 to 13) days for MVR(e), 8 (7 to 11) days for MVR(p), and 8 (7 to 10) days for Repair (P<.01 versus MVR(e); multivariate analysis adjusting for age, rhythm, and NYHA class). Cost per patient was US $14469 for MVR(e), $13151 for MVR(p), and $11606 for Repair.
Conclusions:
Repair and MVR(p) may predict shorter in-hospital stay and reduced cost, although there are important differences in the group of patients who have MVR(e).
Insights
Mitral valve surgery preserving chordae (MVR(p)) and repair lead to shorter hospital stays and lower costs compared to valve excision (MVR(e)). These findings highlight the benefits of less invasive mitral valve interventions.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Economics
Background:
- Mitral valve surgery aims to restore valve function.
- Preserving tendinous chordae during mitral valve repair and replacement (MVR(p)) may offer advantages over valve excision (MVR(e)).
- The impact of MVR technique on in-hospital stay and cost remains unclear.
Purpose of the Study:
- To compare in-hospital stay and costs between mitral valve repair, MVR(p), and MVR(e).
Main Methods:
- Retrospective review of 253 patients undergoing mitral valve surgery for regurgitation (1991-1996).
- Patients categorized into MVR(e), MVR(p), and Repair groups.
- In-hospital costs calculated based on operating room, ICU, and ward expenses.
Main Results:
- Postoperative hospital stay was significantly shorter for Repair (8 days) and MVR(p) (8 days) compared to MVR(e) (10 days).
- Mean costs per patient were $11,606 for Repair, $13,151 for MVR(p), and $14,469 for MVR(e).
- Factors influencing longer stay included age >70, atrial fibrillation, and NYHA class III/IV.
Conclusions:
- Mitral valve repair and MVR(p) are associated with shorter in-hospital stays.
- These less invasive techniques may also lead to reduced healthcare costs.
- Differences in patient characteristics exist among the surgical groups.