Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches: a multi-institution analysis of ‘real world’ data

Abstract

Background:

Large institutional analyses demonstrating outcomes of right anterior mini-thoracotomy (RAT) for isolated aortic valve replacement (isoAVR) do not exist. In this study, a group of cardiac surgeons who routinely perform minimally invasive isoAVR analyzed a cross-section of US hospital records in order to analyze outcomes of RAT as compared to sternotomy.

Methods:

The Premier database was queried from 2007–2011 for clinical and cost data for patients undergoing isoAVR. This de-identified database contains billing, hospital cost, and coding data from >600 US facilities with information from >25 million inpatient discharges. Expert rules were developed to identify patients with RAT and those with any sternal incision (aStern). Propensity matching created groups adjusted for patient differences. The impact of surgical approach on outcomes and costs was modeled using regression analysis and, where indicated, adjusting for hospital size and geographical differences.

Results:

AVR was performed in 27,051 patients. Analysis identified isoAVR by RAT (n = 1572) and by aStern (n = 3962). Propensity matching created two groups of 921 patients. RAT was more likely performed in southern hospitals (63% vs 36%; p < 0.01), teaching hospitals (66% vs 58%; p < 0.01) and larger hospitals (47% vs 30%; p < 0.01). There was significantly less blood product cost associated with RAT ($1381 vs $1912; p < 0.001). After adjusting for hospital differences, RAT was associated with lower cost than aStern ($38,769 vs $42,656; p < 0.01).

Conclusions:

Outcomes analyses can be performed from hospital administrative collective databases. This real world analysis demonstrates comparable outcomes and less cost and ICU time with RAT for AVR.

Keywords::

• Aortic valve
• Minimally invasive surgery
• Cost savings
• Outcomes

Transparency

Declaration of funding

Funding for this project was provided by Edwards Lifesciences. This included funding for access to the Premier database and statistical analysis.

Declaration of financial/other relationships

ER, SCM, AS, GA, EAG are Edwards Lifesciences consultants. MM is an Edwards Lifesciences employee. JRM is on the Edwards Lifesciences medical advisory board. CG is an employee of CTI Clinical Trials and Consulting services which is a paid consultant to Edwards Lifesciences. ER is also a speaker for Medtronic Sorin and is on the Cardionet advisory board. SCM is a Bazter consultant and an Abiomed speaker. GA is an Abbott and Mitralign consultant and an Amcure and St Judes speaker. EAG is a Medtronic consultant and holds Intellectual property with Edwards Lifesciences and Medtronic. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.