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.

Total Chordal Sparing Mitral Valve Replacement in Rheumatic Disease: A Word of Caution.

Total chordal preservation is the standard for mitral valve replacement to maintain long-term left ventricular geometry. Whereas it is appropriate for functional and degenerative mitral regurgitation, the role of chordal sparing in rheumatic valve disease is less well understood, with limited evidence supporting total chordal sparing. Inasmuch as this autoimmune disease affects the subvalvular apparatus in addition to the leaflets, it can be expected to continue after surgical repair. Here we present 2 patients who experienced adverse events associated with total chordal sparing mitral replacement as a result of disease progression with rapid fibrous growth causing inflow obstruction and early prosthetic valve failure.

Community-based priorities for improving nutrition and physical activity in childhood.

Overweight among America's youth has prompted a large response from foundations, government, and private organizations to support programmatic interventions. The architecture for many of these programs was derived from "experts," whereas the perspective of families, and communities--those most affected and most instrumental in altering behavior--is rarely the driving force. Shaping America's Youth (SAY) was established to assess programs that target nutrition and physical activity and to promote the necessary family and community input. In a 2004 report, SAY documented how community efforts are motivated, funded, structured, and evaluated. It identified discordance between that effort and the opinions of experts. To ensure that the voices of families and communities are integrated into such local and national policies and programs, SAY initiated a unique series of 5-day-long town meetings, input from which was independently statistically analyzed. Across a range of demographics, the results indicated that participants perceive the barriers and solutions similarly. There was broad agreement that the family has primary responsibility, starting with a need to focus on improved quality and duration of family time directed at nutrition and activity. Concurrently they identified needed actions from external sources, including clear and consistent nutrition information; ready access to healthy foods; and a built environment that promotes physical activity. Rather than one-dimensional or governmental solutions, they expressed a need for community-based partnerships integrating health care, education, environment, government, and business. Although this citizen-engagement process did not identify specific actions, it defined basic steps that communities must integrate into future approaches.