A Simplified, Reproducible Cost Effective Approach To Robotic Mitral Valve Repair
Casey Hertzenberg, Maureen McKiernan, Emmanuel Daon.
University of Kansas Hospital, Kansas City, KS, USA.
OBJECTIVE: Robotic mitral valve repair (rMVR) has been previously criticized for its increased costs. Having simplified and standardized the technical aspects of rMVR, we aim to evaluate our cost-effective technique of robotic mitral valve repair and compare its overall hospital cost and postoperative results to traditional open mitral valve repair (tMVR). METHODS:We identified all patients who underwent isolated mitral valve repair over a two year period (2013-2014) at the University of Kansas Hospital. Forty-one patients underwent rMVR performed by one surgeon and nineteen patients underwent isolated tMVR. Data analyzed included total direct hospital cost, hospital LOS, ICU LOS, time of operation, aortic cross-clamp time, cardiopulmonary bypass time, and transfusion rate. Two-sample t-test, Wilcoxon rank sum and chi-square tests were utilized to compare the two groups. RESULTS: We found no statistically significant difference in total direct hospital cost between the rMVR ($29,111) and tMVR ($27,594) groups (p = 0.53). Total hospital LOS was similar (6.29 vs 6.15 days, p = 0.16). However, time in ICU was reduced in the rMVR group (47 vs. 63 hours, p = 0.31). Operative time was found to be slightly longer in the rMVR group and was statistically significant (180 vs. 160 minutes, p < 0.05). However, there was no significant difference in cross-clamp (75 vs. 69 minutes, p = 0.16) or cardiopulmonary bypass times (97 vs. 92 minutes, p = 0.38). Lastly, transfusion rates were less in the rMVR group but this was not found to be statistically significant (14% vs 18%, p = 0.53).
CONCLUSIONS: Providing cost effective robotic mitral valve repair can be performed with good results if variable costs are controlled by simplifying operative techniques which avoid the use of expensive specialized cannulae. Although our sample size was limited, a trend towards decreased time in the ICU as well as decreased transfusion rates in the rMVR group was observed. Despite the added costs of robotic technology, we suggest that rMVR is a safe and cost-effective approach to mitral valve repair, while preserving the benefits of minimally invasive cardiac surgery.
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