Medical and economic interest of the use of cryosurgery in the instrumental treatment of atrial fibrillation.

INTRODUCTION: In order to definitively integrate cryosurgery for the surgical treatment of atrial fibrillation (AF) into the therapeutic armamentarium, the medical and economic impact of its use on a population of patients with a high risk of recurrence of postoperative AF must be evaluated. METHOD: An observational study of patients who benefited from cryosurgery between July 2006 and December 2008 was performed. The cost of consumables and hospitalization was determined and compared to that of a control group of 27 patients with preoperative AF that had not benefited from cryosurgery. RESULTS: Twenty-nine patients benefited from cryosurgery during a mitral (65.5%) or aortic intervention (37.9%) to treat a paroxystic (44.8%) or permanent AF (55.2%). More than half of them (58.6%) had a 12-month follow-up; 82.4% of these patients showed a permanent sinus rhythm and 32.6% had stopped their antiarrhythmic medication. There was no significant difference between the duration and cost of hospitalization for the 2 groups. CONCLUSION: Cryosurgery provides a clear clinical and economic advantage with no recurrence of AF, and it reduces antiarrhythmic medication treatment.

[A medical and economic study about use of hemostatic glues in cardiac surgery]. / Etude médicoéconomique en chirurgie cardiaque : application aux colles hémostatiques.

INTRODUCTION: The impact of the use of biological and synthetic glues in cardiac surgery was assessed by an economic and medical study. MATERIAL AND METHODS: The observational prospective study had duration of three months. All the patients undergoing cardiac surgery were included in the study. The end points were medical (blood transfusion) and economic (duration and cost of the stay in hospital). There were 2 groups: treated or not by glues. STATISTICAL ANALYSIS: T Student tests. RESULTS: Among 154 patients, the 2 principal indications were valvular replacement (48%) and coronary artery bypass grafting (37%). Fifty seven (37%) patients received a glue. The number of transfused globular units and the duration of the stay in the intensive care unit were significantly higher (p<0.05) by treated patients. CONCLUSION: Not only the use of glues did not decrease the post-operative bleedings but it increased also the cost of the stay in hospital. Guidelines were validated by the hospital Commission on drugs.