COST IMPLICATIONS OF MITRAL-VALVE REPLACEMENT VERSUS REPAIR IN MITRALREGURGITATION

Background Mitral valve repair and replacement (MVR) with preservation of the tendinous chordae [MVR(p)], may have better results than MVR w ith valve excision [MVR(e)]. It is not known whether the type of surge ry affects in-hospital stay and cost. Methods and Results We reviewed all patients who had mitral valve surgery for regurgitation over 5 yea rs from January 1991. Patients were considered in three groups; MVR(e) , MVR(p), and Repair. Cost was calculated using operating room, intens ive care unit, and ward expenses, not hospital charges. There were a t otal of 253 patients; 84 MVR(e), 42 MVR(p), and 127 Repair. Mean ages and preoperative New York Heart Association (NYHA) classes were simila r 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 hos pital; 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 wa s 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 adj usting for age, rhythm, and NYHA class). Cost per patient was US $1446 9 for MVR(e), $13 151 for MVR(p), and $11606 for Repair. Conclusions R epair and MVR(p) may predict shorter in-hospital stay and reduced cost , although there are important differences in the group of patients wh o have MVR(e).