Cost reduction and improve outcome by using sutureless prosthesis

Objectives: Sutureless aortic valve prostheses have the potential of shortening surgical time. However, whether this time reduction results in improved patient outcomes and hospital costs remain to be established.

Methods: From 2010, 547 patients underwent aortic valve replacement (AVR) with a bioprosthesis both isolated and with concomitant coronary artery bypass grafting (CABG): of these, 112 patients received a sutureless Preceval S bioprosthesis. Based on a propensity-score analysis, 2 groups with 82 matched-pairs were created (group Perceval “P” and group Conventional “C”), with comparable preoperative characteristics. Hospital outcome, follow-up and related costs were recorded.

Results: There were 3 hospital deaths in "C" and 2 in "P" (p = 0.65). Aortic cross-clamp, cardiopulmonary bypass and operation time were 20%, 23% and 16% shorter in "P" (each one p < 0.001). "P" required less frequently blood transfusion (1.2 ± 1.3 vs 2.5 ± 3.7 units, p = 0.005) with a similar incidence of re-exploration (2 vs 5, p = 0.221). Moreover, "P" had a shorter intensive care unit stay (1.9 ± 1.72 vs 2.4 ± 1.3 days, p < 0.001), hospital stay (9.4 ± 3.9 vs 13.3 ± 17.7 days, p < 0.001) and intubation time (6.5 ± 4.6 vs 14.6 ± 6.4 hours, p < 0.001) and a lower incidence of postoperative atrial fibrillation, pleura effusions and respiratory insufficiency (p = 0.015, 0.024 and 0.016, respectively). Pacemaker implantation and incidence of neurological events was not different (p>0.05). The use of Sutureless valve prostheses could result - including the follow-up - in a reduction in resources consumption of about 50%.

Conclusion: Perceval S Sutureless prosthesis allows a better outcome than conventional valves. A propensity score analysis shows a shorter hospitalization, use of blood transfusions and a significant cost reduction.