Medico-economic evaluation of minimally invasive thoracotomy versus sternotomy in heart valve surgeries: An observational study

Objectives: Minimally invasive surgery has many outstanding advantages that make it increasingly popular for the treatment of heart valve disease. However, this approach has been criticised for its long operative aortic clamping times and increased treatment costs. The aim of this study was to compare the cost and clinical effectiveness of minimally invasive surgery and conventional sternotomy in mitral and aortic surgery. Methods: A prospective observational analysis of patients who had undergone mitral aortic valve surgery via minimally invasive approach or sternotomy between 1 May 2021 and 31 July 2021. The statistical analysis focused on differences in cost and advantages between the two surgical approaches. A correlation analysis was conducted to identify key contributors to the overall cost variation. Results: A total of 44 patients met the study criteria. Patients were divided into two groups: minimally invasive surgery and traditional sternotomy. There was no significant difference between the two groups in preoperative status, most patients were in good health, without comorbidities such as kidney disease, thrombosis, hypertension, diabetes, chronic lung disease. The time spent in the operating room (from patient admission to exit), the surgery time, and cardiopulmonary bypass duration were significantly higher for minimally invasive aortic valve replacement than for sternotomy aortic valve replacement (operating room time: 305 ±56 min vs. 249 ±53 min, p=0.029; operative time: 198 ± 54 min vs. 150 ± 54 min, p=0.046; CPB time: 129 ± 53 min vs. 80 ± 31 min; p=0.034). Mortality and complications during hospitalisation were similar between both groups for both mitral and aortic valve replacements. Total cost analysis revealed no statistically significant difference between the two methods (mitral valve replacement: 22 510 ± 6 672 euros vs 24 979 ± 10 196 euros, p=0.438; aortic valve replacement: 16 651 ± 2 855 euros vs 18 202 ± 6 261 euros, p=0.087). Conclusion: In modern clinical practice, minimally invasive surgery is an effective strategy that provides good outcomes with comparable mortality, complications, duration of treatment, and hospital cost, compared with conventional approaches for mitral valve and aortic valve replacements.