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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2003 Aprile;44(2):163-6

CARDIAC SECTION 

 ORIGINAL ARTICLES

Economic impact of mitral valve plasty versus replacement for mitral valve insufficiency

Christenson J. T., Kalangos A.

Clinic for Car­di­o­vas­cular Sur­gery, Uni­ver­sity Hos­pital, ­Geneva, Swit­zer­land

Aim. The prin­cipal tech­niques for sur­gical cor­rec­tion of ­mitral ­valve regur­gi­ta­tion (MR) ­were com­pared, ­with ­emphasis on the eco­nomic ­impact.
­Methods. In a pros­pec­tive non-ran­dom­ized ­study 225 ­patients under­going ­mitral ­valve ­repair ­were ana­lyzed, 75 had ­mitral ­valve ­plasty (MVP) and 150 had ­mitral ­valve replace­ment (MVR). ­Patient dem­o­graphics ­showed no ­group dif­fer­ences.
­Results. Car­di­o­pul­mo­nary ­bypass ­time and ­ischemia ­time ­were ­shorter in the MVP-­group, p<0.0001. Hos­pital mor­tality was ­lower ­after MVP, 2.0% (3/150) com­pared to MVR, 6.7% (5/75). ICU-­stay was ­shorter in the MVP-­group and so was ­length of post­op­er­a­tive hos­pital ­stay, p=0.014. ­Urgent oper­a­tion was the ­only sig­nif­i­cant ­risk ­factor for mor­tality ­after MVP. Re-oper­a­tion, endo­car­ditis, ­grade IV MR, and ­NYHA ­class IV ­were addi­tional ­risk fac­tors in the MVR-­group. Post­op­er­a­tive improve­ments of ­NYHA and ­mitral ­valve func­tion ­were sim­ilar in ­both ­groups. MVP was ­more ­cost effec­tive ­than MVR (18,050 USD or 20,430 ­Euro ­versus 24,824 USD or 28,097 ­Euro, p<0.001).
Con­clu­sion. ­Mitral ­valve ­plasty for MR is effi­cient and asso­ciated ­with ­shorter CPB and ­ischemia ­times as ­well as ­length of ­stay in ICU, ­together ­with a ­lower ­device ­cost, ­which ­makes MVP ­more ­cost effec­tive ­than MVR.

lingua: Inglese


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