Background: While potential benefits of robotic technology include decreased morbidity and improved recovery, some have suggested a prohibitively high cost. This study was undertaken to compare actual hospital costs of robotically assisted cardiac procedures with conventional techniques. Methods: We conducted a retrospective review of clinical and financial data of 20 patients who underwent atrial septal defect (ASD) closure and 20 patients who underwent mitral valve repair (MVr) using either robotic techniques or a conventional approach with a sternotomy. Total hospital cost (actual resource consumption) was subdivided into operative and postoperative costs. Results: Robotic technology did not significantly increase total hospital cost for ASD closure or MVr (p = 0.518 and p = 0.539). However, when including the initial capital investment for the robot through amortization of institutional costs, total hospital cost was increased by $3,773 for robotic ASD closure and $3,444 for robotic MVr (p = 0.021 and p = 0.004). The major driver of cost for robotic cases (operating room time) decreased over time. Conclusions: Robotic technology did not significantly increase hospital cost. While the absolute cost for robotic surgery was higher than conventional techniques after taking into account the institutional cost of the robot, the major driver of cost for robotic procedures will likely continue to decrease, as the surgical team becomes increasingly familiar with robotic technology. Furthermore, other benefits, such as improvement in postoperative quality of life and more expeditious return to work may make a robotic approach cost-effective. Thus, it is possible that the benefits of robotic surgery may justify investment in this technology.

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tudies have demonstrated sex differences in survival after various cardiac procedures, with superior survival for male over female patients. 1 This might be due to a lower threshold to diagnose and aggressively treat heart disease in male patients, resulting in female patients presenting with more advanced pathology and systemic manifestations. 2 This study was designed to analyze our bridge-to-transplant experience since the beginning of our program. Our primary goal was to determine the effect of sex on survival while on support, rates of successful bridging to transplantation, and posttransplantation survival. Patients and MethodsWe retrospectively reviewed our experience with Thoratec Heartmate assist devices from August 1990 through September 2002. One hundred ninety-one (80.9%) male patients and 45 (19.1%) female patients underwent implantation. This included 52 pneumatic (40 male and 12 female patients), 17 dual-lead vented electric (15 male and 2 female patients), and 167 single-lead vented electric (136 male and 31 female patients) devices. Preimplantation left ventricular assist device (LVAD) scores, determined on the basis of a patient's presenting degree of clinical stability and shown to correlate with survival on LVAD support in multivariate analysis, were calculated for male and female patients. 3 The study was performed in accordance with institutional guidelines.Data were represented as frequency distributions and percentages. Values of continuous variables were expressed as means Ϯ SD. Continuous variables were compared by using independent samples t tests, whereas categoric variables were compared by using 2 tests. Kaplan-Meier analysis was used to calculate long-term survival. Significant predictors of survival were identified by using multivariate Cox proportional hazard models. All data were analyzed with SPSS 11.5 software. ResultsDemographics. Clinical characteristics of male and female patients are outlined in Table 1. There was no significant difference in age, race, or cause of heart failure (P ϭ not significant). Male patients had a significantly higher body surface area than female patients (2.0 Ϯ 0.2 vs 1.8 Ϯ 0.2 kg/m 2 , P Ͻ .001). LVAD implantation scores were significantly higher for female patients than male patients (6.4 Ϯ 3.1 vs 4.2 Ϯ 3.2, P ϭ .020). Median support time was similar between the groups (51.5 days [0-541 days] for male patients and 46.0 [0-397 days] for female patients, P ϭ .412).Survival on LVAD and transplantation rate. Survival on LVAD support was significantly higher for male patients than for female patients (78.5% [n ϭ 150] vs 62.2% [n ϭ 28], P ϭ .022). Successful bridging to transplantation was also significantly higher for male patients than for female patients (72.8% [n ϭ 139] vs 57.8% [n ϭ 26], P ϭ .048).Posttransplantation survival. Male patients demonstrated significantly improved post-

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