Abstract
Between January 1992 and December 1993, 46 Inoue Mitral Commissurotomies (IMV) were performed as part of a Multicenter Investigation. In the same period, 19 IMV-eligible open mitral valvuloplasties (OMV) were performed for mitral stenosis. There were no differences in baseline characteristics (p = NS):Empty CellAge (mean)FemaleEcho score (mean)Valve area (mean)IMV51.4 ± 12.0187.0%7.1 ± 151.1 cm2OMV53.6 ± 12.994.7%77 ± 251.1 cm2 93.5% of IMV were successful without valve surgery. Median costs (in 1993 dollars) using the Transition Systems Inc. accounting method. and length of stay (LOS) were higher for OMV than IMV (p < 0.001). Deaths and Strokes were similar:Empty CellDeathStrokeLOS (days)Cost ($)IMV2.2%0.0%15,210OMV5.3%0.0%719,692 Correlates of IMV cost in multivariable stepwise regression analysis were:Mitral valve replacementp = 0.0001Hospital delay > 24 hours prior to IMVP = 0.0035Final trans-mitral gradientp = 0.0263 After controlling for LOS, intra-procedural transesophageal echocardiography predicted higher cost (p = 0.006). In conclusion, IMV is an effective short-stay cost minimizing strategy in appropriate patients. Cost savings can be obtained by expeditiously achieving a low residual gradient while avoiding mitral valve replacement. The cost-benefit of routine transesophageal echocardiography requires further study.
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