Laborde François, Folliguet Thierry, Ghorayeb Gabriel, Zannis Konstantinos
Département de Pathologie Cardiaque, Institut Mutualiste Montsouris, Paris, France. Electronic correspohdence:
CHU brabois, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, Vandoeuvre les Nancy, Université de Lorraine, France.
J Heart Valve Dis. 2017 Jan;26(1):1-8.
The study aim was to assess differences in clinical outcome, safety, and associated costs between sutureless and aortic isolated aortic valve replacement (AVR) with a standard bioprosthesis.
A retrospective comparative study was conducted to investigate 65 patients, each of whom had undergone isolated AVR with a traditional aortic valve (T) or a Perceval S sutureless aortic prosthesis (P) between January 2010 and December 2012. Cost data were drawn from the proprietary cost accounting system of the hospital, excluding acquisition costs of the devices. A linear regression model was used to estimate the mean total costs difference between groups.
The mean cardiopulmonary bypass time and aortic cross-clamp times in the T and P groups were 80 ± 41 min and 58 ± 26 min versus 38 ± 16 min and 26 ± 10 min, respectively (p <0.0001). The mean intensive care unit and ward stays in both groups were 4.2 ± 5.9 and 11.9 ± 6.5 days versus 3.8 ± 4.7 and 10 ± 4.5 days, respectively (p = 0.68 and p = 0.05). The mean costs savings for group P compared to group T were €3,801 (p = 0.13), mainly driven by hospital stay costs. Savings between the P and T groups increased with age: €4,992 in patients aged 70-79 years and €9,326 in those aged 80+ years, and with risk (€4,296 for high-risk patients).
Sutureless aortic valves present shorter procedural times and lower hospital costs compared to traditional valves, with higher cost savings at increased patient age and risk. Sutureless aortic valves seem to be cost-effective in patients undergoing AVR.
本研究旨在评估无缝合与采用标准生物假体的主动脉孤立性主动脉瓣置换术（AVR）在临床结局、安全性及相关成本方面的差异。
进行了一项回顾性比较研究，调查了65例患者，他们在2010年1月至2012年12月期间均接受了传统主动脉瓣（T）或Perceval S无缝合主动脉假体（P）的孤立性AVR。成本数据来自医院的专有成本核算系统，不包括设备购置成本。采用线性回归模型估计两组之间的平均总成本差异。
T组和P组的平均体外循环时间和主动脉阻断时间分别为80±41分钟和58±26分钟，而P组为38±16分钟和26±10分钟（p<0.0001）。两组的平均重症监护病房和病房住院时间分别为4.2±5.9天和11.9±6.5天，而P组为3.8±4.7天和10±4.5天（p=0.68和p=0.05）。与T组相比，P组平均节省成本3801欧元（p=0.13），主要由住院费用驱动。P组和T组之间的节省成本随着年龄增长而增加：70-79岁患者为4992欧元，80岁及以上患者为9326欧元，且与风险相关（高危患者为4296欧元）。
与传统瓣膜相比，无缝合主动脉瓣手术时间更短，医院成本更低，随着患者年龄增长和风险增加，节省成本更高。无缝合主动脉瓣在接受AVR的患者中似乎具有成本效益。
