PMID- 9386081
OWN - NLM
STAT- MEDLINE
DCOM- 19971212
LR  - 20041117
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 96
IP  - 9 Suppl
DP  - 1997 Nov 4
TI  - Cost implications of mitral valve replacement versus repair in mitral 
      regurgitation.
PG  - II-90-3; discussion II-94-5
AB  - BACKGROUND: Mitral valve repair and replacement (MVR) with preservation of the 
      tendinous chordae [MVR(p)], may have better results than MVR with valve excision 
      [MVR(e)]. It is not known whether the type of surgery affects in-hospital stay 
      and cost. METHODS AND RESULTS: We reviewed all patients who had mitral valve 
      surgery for regurgitation over 5 years from January 1991. Patients were 
      considered in three groups; MVR(e), MVR(p), and Repair. Cost was calculated using 
      operating room, intensive care unit, and ward expenses, not hospital charges. 
      There were a total of 253 patients; 84 MVR(e), 42 MVR(p), and 127 Repair. Mean 
      ages and preoperative New York Heart Association (NYHA) classes were similar in 
      the three groups. There were more male patients in the Repair (62%) and MVR(p) 
      (67%) groups than in the MVR(e) (44%) group (P<.05), and more patients with 
      degenerative etiology in the Repair group (P<.01). A majority of MVR(e) were in 
      atrial fibrillation (63%), while 59% of Repair were in sinus rhythm (P<.01). Of 9 
      patients who died in the hospital; four had MVR(e), 3 had MVR(p), and 2 had 
      Repair. In univariate analyses, in-hospital stay increased with patient age >70 
      years (P<.01), preoperative atrial fibrillation (P<.05), and NYHA class III or IV 
      (P<.01). The median and interquartile ranges for postoperative stay was 10 (8 to 
      13) days for MVR(e), 8 (7 to 11) days for MVR(p), and 8 (7 to 10) days for Repair 
      (P<.01 versus MVR(e); multivariate analysis adjusting for age, rhythm, and NYHA 
      class). Cost per patient was US $14469 for MVR(e), $13151 for MVR(p), and $11606 
      for Repair. CONCLUSIONS: Repair and MVR(p) may predict shorter in-hospital stay 
      and reduced cost, although there are important differences in the group of 
      patients who have MVR(e).
FAU - Barlow, C W
AU  - Barlow CW
AD  - Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United 
      Kingdom.
FAU - Imber, C J
AU  - Imber CJ
FAU - Sharples, L D
AU  - Sharples LD
FAU - Heriot, A G
AU  - Heriot AG
FAU - Wells, F C
AU  - Wells FC
FAU - Large, S R
AU  - Large SR
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cost-Benefit Analysis
MH  - Female
MH  - *Health Care Costs
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/*surgery
EDAT- 1997/12/31 00:00
MHDA- 1997/12/31 00:01
CRDT- 1997/12/31 00:00
PHST- 1997/12/31 00:00 [pubmed]
PHST- 1997/12/31 00:01 [medline]
PHST- 1997/12/31 00:00 [entrez]
PST - ppublish
SO  - Circulation. 1997 Nov 4;96(9 Suppl):II-90-3; discussion II-94-5.