Pagani F D, Benedict M B, Marshall B L, Bolling S F
Department of Surgery, University of Michigan Hospitals, Ann Arbor 48109-0344, USA.
J Heart Valve Dis. 1997 Sep;6(5):466-9.
Comparisons of mitral valve (MV) replacement and reconstruction have demonstrated lower overall complication rates, better left ventricular (LV) function, and inferred overall lower cost for the latter procedure compared with the former. However, assessment of economic differences between the two procedures in routine cases, without complications, has not been reported. This study retrospectively evaluates the economic impact of uncomplicated MV repair versus replacement.
As this study seeks only to evaluate economic comparisons between routine cases of mitral repair versus replacement, those patients having concomitant procedures performed (coronary revascularization or other valve procedure) or postoperative complications (i.e. pulmonary failure, wound infections, new-onset atrial fibrillation, return for bleeding, or neurologic sequelae) were excluded from the study. Among patients who underwent uncomplicated MV procedures, 30 were selected at random and reviewed.
Variables for MV replacement versus reconstruction included aortic cross-clamp time (112 +/- 54 versus 92 +/- 20 min; p = NS), cardiopulmonary bypass (CPB) time (189 +/- 70 versus 128 +/- 18 min; p < 0.05), total hospital stay (8.3 +/- 1.6 versus 5.6 +/- 1.6 days; p < 0.0001), and total hospital charges ($44,697 +/- 4903 versus $31,337 +/- 4484; p < 0.0001), respectively.
These data suggest that, beyond the recognized benefits of MV reconstruction, namely preservation of LV function and avoidance of long-term anticoagulation, there is an economic advantage to MV reconstruction for patients and payors, even in uncomplicated cases. These differences may become more apparent with longer follow-up and in patients having poor function or combined procedures. This finding reinforces the idea that MV reconstruction is the option of choice for patients with mitral regurgitation.
二尖瓣（MV）置换术与重建术的比较表明，与前者相比，后者的总体并发症发生率更低、左心室（LV）功能更好，且总体成本更低。然而，尚未有关于这两种手术在无并发症的常规病例中的经济差异评估报告。本研究回顾性评估了无并发症的MV修复术与置换术的经济影响。
由于本研究仅旨在评估二尖瓣修复术与置换术常规病例之间的经济比较，因此将那些同时进行其他手术（冠状动脉血运重建或其他瓣膜手术）或术后出现并发症（即肺功能衰竭、伤口感染、新发房颤、因出血返回或神经系统后遗症）的患者排除在研究之外。在接受无并发症MV手术的患者中，随机选择30例进行回顾。
MV置换术与重建术的变量分别包括主动脉阻断时间（112±54分钟对92±20分钟；p=无显著性差异）、体外循环（CPB）时间（189±70分钟对128±18分钟；p<0.05）、总住院时间（8.3±1.6天对5.6±1.6天；p<0.0001）和总住院费用（44,697±4903美元对31,337±4484美元；p<0.0001）。
这些数据表明，除了MV重建术公认的益处，即保留LV功能和避免长期抗凝外，对于患者和支付方而言，即使在无并发症的情况下，MV重建术也具有经济优势。随着随访时间延长以及在功能较差或进行联合手术的患者中，这些差异可能会更加明显。这一发现强化了MV重建术是二尖瓣反流患者首选治疗方法的观点。
