Cost‐analysis of percutaneous pulmonary valve implantation compared to surgical pulmonary valve replacement

Vergales, Jeffrey; Wanchek, Tanya; Novicoff, Wendy M.; Krön, Irving L.; Lim, D. Scott

doi:10.1002/ccd.25128

Cited by 24 publications

(18 citation statements)

References 20 publications

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“…The surgical alternative with valved conduit implantation requires longer hospital stay, is not free of either early or late complications, and requires repeated re-interventions of increasing complexity and risk. A recent report from Vergales et al shows that in the USA the total cost of PPVI is less than surgical valve replacement and that it would require a very dramatic short term survival of the PPVI to be less competitive; this study reflects the US financial data but cannot be extrapolated to the European situation [26]. [27]…”

Section: Discussionmentioning

confidence: 82%

Medium term follow-up after percutaneous pulmonary valve replacement with the Melody® valve

Cools

Budts

Heying

et al. 2015

IJC Heart & Vasculature

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IntroductionData on long term function of the Melody valve are scarce.Patients and methods: single institution; results of percutaneous pulmonary valve implantation (PPVI) from 2006 to 2014. The function of the valved conduit was analyzed by Doppler echocardiography. Annual Chest X-ray after implant and permanent screening for events (e.g. Endocarditis).Results112 Melody valves were implanted in 111 patients; mean age 19.3 years (4.5–81.6). No pre-stenting of the RVOT was performed (n = 4) at first. In the next 107 patients pre-stenting was always performed. In 82 patients 1 pre-stent, 18 patients 2, in 6 patients 3 stents and 1 patient 4 stents were used. The Melody stent was dilated up to 24 mm (n = 4), 22 mm (n = 72), 20 mm (n = 28) and 18 mm (n = 6). When stenotic, the Doppler gradient reduced from 67.0 mm Hg (SD 13.9) to 18.9 mm Hg (SD 10.4) (p < 0.001); pulmonary regurgitation (PR) was reduced from median 3.5/4 (range 0–4/4) to none or trivial (p < 0.001). There was no significant change in RVOT peak velocity at 5 years (p = 0.122) nor PR (p = 0.835). Type 1 stent fractures were observed in 1/4 non-pre-stented patients and in 5/107 pre-stented (p < 0.05).Endocarditis occurred in 8/112 valves; freedom of endocarditis was 85% at 5 years. In 2 patients early surgical replacement was necessary. Six were sterilized with antibiotic treatment; 2 patients required re-stenting and re-PPVI due to residual gradient.ConclusionAdequate pre-stenting of the RVOT before PPVI nearly abolishes or delays stent fracture. Cusp function is well preserved in mid-term follow-up; endocarditis is a threat.

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Section: Discussionmentioning

confidence: 82%

Medium term follow-up after percutaneous pulmonary valve replacement with the Melody® valve

Cools

Budts

Heying

et al. 2015

IJC Heart & Vasculature

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“…Recurrent changes in their health,6 initiate new treatment demands . A mean length of a hospital stay after a change of the pulmonary valve was 5.7 days with a mean stay of 2.8 in the intensive care unit 7. Patients treated with percutaneous pulmonary valve implantation went home 1 day after treatment 7.…”

Section: Introductionmentioning

confidence: 99%

“…A mean length of a hospital stay after a change of the pulmonary valve was 5.7 days with a mean stay of 2.8 in the intensive care unit 7. Patients treated with percutaneous pulmonary valve implantation went home 1 day after treatment 7. In a limited number of studies investigating experiences in patients with congenital heart disease using qualitative methods, normalisation is documented to be a central issue 6 8–10.…”

Section: Introductionmentioning

confidence: 99%

Perceived health after percutaneous pulmonary valve implantation: in-depth interviews of patients and next-of-kin

et al. 2014

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ObjectivePercutaneous pulmonary valve implantation is an alternative to open heart surgery in selected patients with pulmonary outflow tract disorder. The technique may reduce the number of open-chest surgeries in these patients. This study was conducted to understand how the patients and their next-of-kin experienced this new treatment option.DesignQualitative explorative design with individual in-depth interviews.SettingOslo University Hospital, the only cardiac centre in Norway offering advanced surgical and interventional treatment to patient with congenital heart defects, serving the whole Norwegian population.ParticipantsDuring a 2-year period a total of 10 patients, median age 17 (7–30) and 18 next-of-kin were consecutively selected for individual in-depth interviews 3–6 months after the pulmonary valve implantation. The verbatim transcripts were analysed using a phenomenological methodology.ResultsPatients emphasised the importance of regaining independence and taking control of daily life shortly after the new interventional treatment. Renewed hope towards treatment options was described as ‘a light in the tunnel’. Next-of-kin emphasised the importance both for the patient and their family of resuming normal life quickly after the procedure. The physical burden was experienced as minor after the minimally invasive intervention, compared to their previous experience with surgical procedures.Main outcome measureThe importance of maintaining normality in everyday life for a good family function.ConclusionsThe repeated surgeries during infancy and adolescence of patients with congenital heart disease represent a heavy burden both for the patient and their family. All families especially emphasised the importance of resuming normal life quickly after each procedure. The novel technique of pulmonary valve implantation is thus a favourable approach because of minor interference in daily life.

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“…As percutaneous techniques become more frequent and more companies enter the market a reduction in the device cost may be expected and thus give a more favourable in-hospital cost outcome [17, 18]. …”

Section: Discussionmentioning

confidence: 99%

In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery

Andresen

Mishra

Lewandowska

et al. 2016

Eur J Cardiothorac Surg

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OBJECTIVES: Today, both surgical and percutaneous techniques are available for pulmonary valve implantation in patients with right ventricle outflow tract obstruction or insufficiency. In this controlled, non-randomized study the hospital costs per patient of the two treatment options were identified and compared. METHODS: During the period of June 2011 until October 2014 cost data in 20 patients treated with the percutaneous technique and 14 patients treated with open surgery were consecutively included. Two methods for cost analysis were used, a retrospective average cost estimate (overhead costs) and a direct prospective detailed cost acquisition related to each individual patient (patient-specific costs). RESULTS: The equipment cost, particularly the stents and valve itself was by far the main cost-driving factor in the percutaneous pulmonary valve group, representing 96% of the direct costs, whereas in the open surgery group the main costs derived from the postoperative care and particularly the stay in the intensive care department. The device-related cost in this group represented 13.5% of the direct costs. Length-of-stay-related costs in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060) in the open surgery group. The difference in postoperative stay between the groups was statistically significant (P≤ 0.001). CONCLUSIONS: Given the high postoperative cost in open surgery, the percutaneous procedure could be cost saving even with a device cost of more than five times the cost of the surgical device.

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Cost‐analysis of percutaneous pulmonary valve implantation compared to surgical pulmonary valve replacement

Abstract: PPVI holds a significant cost advantage over the surgical approach, fewer hospital days, and incurs less patient wage loss. Furthermore, it would need to have a very high failure rate at 10 years to lose its cost advantage.

Cited by 24 publications

References 20 publications

Medium term follow-up after percutaneous pulmonary valve replacement with the Melody® valve

Medium term follow-up after percutaneous pulmonary valve replacement with the Melody® valve

Perceived health after percutaneous pulmonary valve implantation: in-depth interviews of patients and next-of-kin

In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery

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