Cost Analysis of Minimally Invasive Mitral Valve Surgery in the UK National Health Service

Perin, Giordano; Shaw, Matthew; Toolan, Caroline; Palmér, Kenneth; Al-Rawi, Omar; Modi, Paul

doi:10.1016/j.athoracsur.2020.08.020

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…There are several reasons we favour TAxA access over other well-established minithoracotomy approaches. TAxA provides direct vision of the mitral valve apparatus, enhancing a favourable surgical setting without increasing the complexity of the procedure and thus reducing operative times as seen in our reported values of cross-clamp and cardiopulmonary times which are significantly lower than those usually reported in minithoracotomy surgery experiences [1,16,17]. In addition, through a TAxA incision, the aortic valve and tricuspid valve are both accessible for repair and replacement, as is the left atrial appendage through the transverse sinus.…”

Section: Discussionmentioning

confidence: 71%

“…The recent implementation of enhanced recovery after cardiac surgery protocols has undoubtedly the merit of focusing on the increasing demand from patients for a better surgical experience [16][17][18][23][24][25][26]. Nevertheless, guaranteeing long-term durable results remains one the essential peculiarities of surgical mitral valve repair.…”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes

Bifulco,

Malvindi,

Berretta

et al. 2023

Medicina

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Background and Objectives: Minimally invasive cardiac surgery is an established approach for the treatment of heart valve pathologies and is associated with excellent technical and early postoperative outcomes. Data from medium- and long-term longitudinal evaluation of patients who underwent mitral valve repair (MVr) through transaxillary approach (TAxA) are still lacking. The aim of this study is to investigate mid-term results in patients who underwent TAxA MVr. Materials and Methods: Prospectively collected data of patients who underwent first-time MVr for MV regurgitation between 2017 and 2022, were reviewed. A total of 308 patients received TAxA, while in 220 cases, traditional full sternotomy (FS) was performed. Concomitant aortic and coronary artery bypass grafting (CABG) procedures, infective endocarditis or urgent operations were excluded. A propensity match (PS) analysis was used to overcome preoperative differences between the populations. Follow-up data were retrieved from outpatients’ clinic, telephone calls and municipal administration records. Results: After PS-matching, two well-balanced cohorts of 171 patients were analysed. The overall 30-day mortality rate was 0.6% in both cohorts. No statistical difference in postoperative complications was reported. TAxA cohort experienced earlier postoperative extubation (p < 0.001) with a higher rate of extubation performed in the operating theatre (p < 0.001), shorter intensive care unit (ICU) stay (p < 0.001), and reduced hospitalization with 51% of patients discharged home (p < 0.001). Estimated survival at 5 years was 98.8% in TAxA vs. 93.6% in FS cohort (Log rank p = 0.15). The cumulative incidence of reoperation was 2.6% and 4.4% at 5 years, respectively, in TAxA and FS cohorts (Gray test p = 0.49). Conclusions: TAxA approach for MVr was associated with low rates of in-hospital mortality and major postoperative complications being furthermore associated with shorter mechanical ventilation time, shorter ICU stay and reduced hospitalization with a higher rate of patients able to be discharged home. At mid-term, TAxA was associated with excellent survival and low rate of MV reoperation.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes

Bifulco,

Malvindi,

Berretta

et al. 2023

Medicina

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“…It should be emphasized that in terms of total hospitalization costs, three of the studies 7,23,27 involved and performed statistical analysis, among which Zhu Yilin 27 ( p = .391, T‐MVS vs. M‐MVS vs. C‐ MVS), Coyan 7 ( p = .273, R‐MVS vs. C‐MVS) directly compared the results with no statistical difference; while Liu's study 23 suggested that the difference was statistically significant ( p = .002, T‐MVS vs. C‐MVS). Perin 34 and others abroad reported that the total hospitalization cost of minimally invasive and C‐MVS mitral valve surgery is not different: the high surgical cost of minimally invasive surgery is lowered by the lower postoperative cost. The cost is offset, and the length of hospital stay is shortened by about 2 days, which is consistent with the author's research results to a certain extent.…”

Section: Discussionmentioning

confidence: 96%

Comparative efficacy of five surgical methods in the treatment of mitral regurgitation: A systematic review and network meta‐analysis

Huang

Hou

et al. 2021

Journal of Cardiac Surgery

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Objective This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using the network meta‐analysis method, so as to provide reference for clinical selection of the best surgical scheme. Methods The PubMed, EMBASE, the Cochrane Library, CNKI, and Chongqing VIP Information databases were comprehensively searched until December 2020. We collected retrospective comparative studies on surgical procedures including 3D endoscopic mitral valve surgery (3D‐MVS), robot‐assisted mitral valve surgery (R‐MVS); totally thoracoscopic mitral valve surgery (T‐MVS), small incision mitral valve surgery (M‐MVS), and traditional thoracotomy mitral valve surgery (C‐MVS). Stata16.0 and Addis1.16.8 software was used for network meta‐analysis using the Bayesian approach. Results A total of 31 studies were included, 12,998 patients, involving five surgical methods. Network meta‐analysis showed that: in terms of complications (odds ratio [OR]: 0.65, 95% CI: 0.13–3.00, probability rank = 0.37) and MR (OR: 0.03, 95% CI: 0.0–8315, probability rank = 0.64), the 3D‐MVS group had the lowest event rate. In terms of blood transfusion rate (OR: 0.55, 95% CI: 0.16–1.84, probability rank = 0.45), T‐MVS had the lowest event rate. In addition, with the exception of operation time and chest drainage, the R‐MVS group has the best curative effect. Conclusion This minimally invasive surgery has their own advantages and disadvantages. Overall, 3D‐MVS is most satisfactory, but more samples are needed.

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“…It should be emphasized that in terms of total hospitalization costs, three of the studies [7,23,27] involved and performed statistical analysis, among which Zhu Yilin [27] (P=0.391, T-MVS vs M-MVS vs C-MVS), Coyan [7] (P=0.273, R-MVS vs C-MVS) directly compared the results with no statistical difference; while Liu's study [23] suggested that the difference was statistically significant (P=0.002, T -MVS vs C-MVS). Perin [34] and others abroad reported that the total hospitalization cost of minimally invasive and C-MVS mitral valve surgery is not different: the high surgical cost of minimally invasive surgery is lowered by the lower postoperative cost. The cost is offset, and the length of hospital stay is shortened by about 2 days, which is consistent with the author's research results to a certain extent.…”

Section: Discussionmentioning

confidence: 96%

Comparative efficacy of 5 surgical methods in the treatment of mitral regurgitation: a systematic review and network meta-analysis

Huang¹,

Hou²,

Zhang³

et al. 2021

Preprint

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Objective This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using network meta-analysis method, so as to provide reference for clinical selection of the best surgical scheme. Methods The PubMed, EMBASE, the Cochrane Library, CNKI and Chongqing VIP Information databases were comprehensively searched until December 2020. We collected retrospective comparative studies on surgical procedures including 3D endoscopic mitral valve surgery(3D-MVS), robot assisted mitral valve surgery(R-MVS); totally thoracoscopic mitral valve surgery(T-MVS), small incision mitral valve surgery (M-MVS) and traditional thoracotomy mitral valve surgery(C-MVS). Addis1.16.8 software was used for network meta-analysis. Results A total of 31 studies were included, 12998 patients, involving 5 surgical methods. Network Meta analysis showed that: in terms of complications (OR: 0.65, 95% CI: 0.13 to 3.00, probability rank = 0.37) and mitral regurgitation (OR:0.03, 95%CI: 0.0 to 8315, probability rank=0.64), the 3D-MVS group had the lowest event rate. In terms of blood transfusion rate (OR: 0.55, 95% CI: 0.16 to 1.84, probability rank=0.45), T-MVS had the lowest event rate. In addition, with the exception of operation time and chest drainage, the R-MVS group has the best curative effect. Conclusion These minimally invasive surgery has their own advantages and disadvantages. Overall, 3D-MVS is most satisfactory, but more samples are needed.

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Cost Analysis of Minimally Invasive Mitral Valve Surgery in the UK National Health Service

Cited by 8 publications

References 13 publications

Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes

Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes

Comparative efficacy of five surgical methods in the treatment of mitral regurgitation: A systematic review and network meta‐analysis

Comparative efficacy of 5 surgical methods in the treatment of mitral regurgitation: a systematic review and network meta-analysis

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