Minimally Invasive Cardiac Valve Surgery Improves Patient Satisfaction While Reducing Costs of Cardiac Valve Replacement and Repair

Abstract

ObjectiveThis study compares the quality of valve replacement and repair performed through minimally invasive incisions as compared to the standard operation for aortic and mitral valve replacement. Summary Background DataWith the advent of minimally invasive laparoscopic approaches to orthopedic surgery, urology, general surgery, and thoracic surgery, it now is apparent that standard cardiac valve operations can be performed through very small incisions with similar approaches. MethodsEighty-four patients underwent minimally invasive aortic (n = 41) and minimally invasive mitral valve repair and replacement (n = 43) between July 1996 and April 1997. Demographics, procedures, operative techniques, and postoperative morbidity and mortality were calculated, and a subset of the first 50 patients was compared to a 50-patient cohort who underwent the same operation through a conventional median sternotomy. Demographics, postoperative morbidity and mortality, patient satisfaction, and charges were compared. ResultsOf the 84 patients, there were 2 operative mortalities both in class IV aortic patients from multisystem organ failure. There was no operative mortality in the patients undergoing mitral valve replacement or repair. The operations were carried out with the same accuracy and attention to detail as with the conventional operation. There was minimal postoperative bleeding, cerebral vascular accidents, or other major morbidity. Groin cannulation complications primarily were related to atherosclerotic femoral arteries. A comparison of the minimally invasive to the conventional group, although operative time and ischemia time was higher in minimally invasive group, the requirement for erythrocytes was significantly 421

Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

“…Reductions in postoperative bleeding and transfusion requirements after minimally invasive mitral valve surgery are likely due to smaller incisions and less extensive mediastinal dissection (5,7,8,(17)(18)(19)(20)(21)(22)(23). Other centers, including our own, have also demonstrated significant associations between less invasive mitral valve surgery and reduced bleeding and transfusion (7).…”

“…P r o c e d u r a l c o s t a n d r e s o u r c e u t i l i z a t i o n a r e increasingly important factors in evaluating different treatments. Multiple groups demonstrated that shorter hospital stays after less invasive mitral valve surgery translate to cost saving ranging from 7% to 34% (18,19,33). Further economic benefit may stem from lower rehabilitation requirements and lower rates of early rehospitaliztion (7,18).…”

“…Multiple groups demonstrated that shorter hospital stays after less invasive mitral valve surgery translate to cost saving ranging from 7% to 34% (18,19,33). Further economic benefit may stem from lower rehabilitation requirements and lower rates of early rehospitaliztion (7,18). In an in-depth economic analysis of cost differences between minimally invasive and sternotomy approaches to mitral valve surgery, Iribarne and colleagues concluded that minimally invasive mitral valve surgery was both cost effective and cost saving: minimally invasive operations were associated with average savings of greater than $9,000 per patient (34).…”

015 * Propensity Score Analysis of Outcomes Following Minimally Invasive Versus Conventional Aortic Valve Replacement

“…A-Upper Partial Sternotomy (J-shaped Hemisternotomy) approach: It is considered the most common approach in MIAVR nowadays (L. H. Cohn et al, 1997;Cosgrove & Sabik, 1996). Skin incision would be 6-8 cm in the midline over the upper part of the sternum extending from the suprasternal notch up to the 3 rd or 4 th intercostal space.…”

Correção de defeitos cardíacos congênitos simples em crianças e adolescentes por meio de minitoracotomias

“…Potential advantages include improved cosmetic results and comfort for the patient as well as shorter hospital stays, which impact on total cost 9 . Approaches that are widely used for the pediatric population include the anterior thoracotomy 5,8,[10][11] and upper or lower minimal access sternotomy [12][13][14] , with or without video assistance.…”