Cost-Effectiveness and Clinical Outcome of Transcatheter Versus Sutureless Aortic Valve Replacement.

IF 0.7 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Surgery Forum Pub Date : 2023-06-25 DOI:10.1532/hsf.5445
Cenk Indelen, Tolga Bas, Ahmet Kar, Ebsar Ergenç, Burcin Cayhan Karademir, Mesut Sismanoglu, Kaan Kirali
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Abstract

Background: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are becoming increasingly common. The aim of this study is to compare the clinical outcome and cost-effectiveness of the two methods.

Methods: In this study, cross-sectional retrospective data were collected on 327 patients who underwent SU-AVR (n = 168) and TAVI (n = 159). Homogeneous groups were provided by the "propensity score matching" method, and 61 patients from the SU-AVR group and 53 patients from the TAVI group were included in the study sample.

Results: The two groups did not have statistically different death rates, complications after surgery, lengths of hospital stays, or visits to the intensive care unit. It is stated that the SU-AVR method provides an additional 1.14 Quality-Adjusted Life Year (QALY) compared to the TAVI method. The TAVI was more expensive than the SU-AVR in our study, but the difference was not statistically significant ($40,520.62 vs. $38,405.62, p > 0.05). For SU-AVR, the most expensive factor was the length of stay in the intensive care unit; for TAVI, it was arrhythmia, bleeding, and renal failure.

Conclusions: These bioprostheses are safe and effective treatments for valve stenosis. Clinical outcomes were similar between the two groups. Therefore, clinicians may find it difficult to determine an effective treatment strategy. According to the evaluation made in terms of cost-effectiveness, it was found that the SU-AVR method gave a higher QALY at a lower cost compared to the TAVI method. However, this result is not statistically significant.

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经导管与无缝合主动脉瓣置换术的成本-效果和临床结果。
背景:无缝线主动脉瓣置换术(SU-AVR)和经导管主动脉瓣植入术(TAVI)越来越普遍。本研究的目的是比较两种方法的临床结果和成本效益。方法:本研究收集327例SU-AVR (n = 168)和TAVI (n = 159)患者的横断面回顾性资料。采用“倾向评分匹配”方法提供同质组,研究样本分别为SU-AVR组61例和TAVI组53例。结果:两组患者的死亡率、术后并发症、住院时间或重症监护病房就诊次数均无统计学差异。与TAVI方法相比,SU-AVR方法提供了额外的1.14质量调整生命年(QALY)。在我们的研究中,TAVI比SU-AVR更昂贵,但差异无统计学意义($40,520.62 vs $38,405.62, p > 0.05)。对于SU-AVR,最昂贵的因素是在重症监护病房的停留时间;对于TAVI,则是心律失常、出血和肾功能衰竭。结论:生物假体是治疗瓣膜狭窄安全有效的方法。两组临床结果相似。因此,临床医生可能发现很难确定有效的治疗策略。从成本-效果的角度进行评价,发现与TAVI方法相比,SU-AVR方法以较低的成本获得了更高的QALY。然而,这一结果在统计学上并不显著。
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来源期刊
Heart Surgery Forum
Heart Surgery Forum 医学-外科
CiteScore
1.20
自引率
16.70%
发文量
130
审稿时长
6-12 weeks
期刊介绍: The Heart Surgery Forum® is an international peer-reviewed, open access journal seeking original investigative and clinical work on any subject germane to the science or practice of modern cardiac care. The HSF publishes original scientific reports, collective reviews, case reports, editorials, and letters to the editor. New manuscripts are reviewed by reviewers for originality, content, relevancy and adherence to scientific principles in a double-blind process. The HSF features a streamlined submission and peer review process with an anticipated completion time of 30 to 60 days from the date of receipt of the original manuscript. Authors are encouraged to submit full color images and video that will be included in the web version of the journal at no charge.
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