Minimally invasive mitral valve surgery is associated with excellent resource utilization, cost, and outcomes

Objectives: Minimally invasive mitral valve surgery (mini-MVR) has numerous associated benefits. However, many studies fail to include greater-risk patients. We hypothesized that a minimally invasive approach in a representative cohort provides excellent outcomes with reduced resource utilization. Methods: Mitral valve surgical records from 2011 to 2016 were paired with institutional financial records. Patients were stratified by approach and propensity-score matched to balance preoperative difference. The primary outcomes of interest were resource utilization including cost, discharge to a facility, and readmission. Results: A total of 478 patients underwent mitral surgery (21% mini-MVR) and were balanced after matching (n = 74 per group), with 18% of patients having nondegenerative mitral disease. Outcomes were excellent with similar rates of major morbidity (9.5% mini-MVR vs 10.8% conventional, P =.78). Mini-MVR cases had lower rates of transfusion (11% vs 27%, P =.01) and shorter ventilator times (3.7 vs 6.0 hours, P <.0001). Mean total hospital cost was equivalent ($49,703 vs $54,970, P =.235) with mini-MVR having lower ancillary ($1645 vs $2652, P =.001) and blood costs ($383 vs $1058, P =.001). These savings were offset by longer surgical times (291 vs 234 minutes, P <.0001) with greater surgical ($7645 vs $7293, P =.0001) and implant costs ($1148 vs $748, P =.03). Rates of discharge to a facility (9.6% vs 16.2%) and readmission (9.6% vs 4.1%) were not statistically different. Conclusions: In a real-world cohort, mini-MVR continues to demonstrate excellent results with a favorable resource utilization profile. Greater surgical and implant costs with mini-MVR are offset by decreased transfusions and ancillary needs leading to equivalent overall hospital cost.