Quality of Life Shift after Aortic Valve Replacement in the Era of TAVI: Single-Center Class Comparison Study Between Different Procedural Techniques.

BACKGROUND AND AIM OF THE STUDY: The health-related quality of life (QOL) is one of the most important outcome indicators for elderly people undergoing aortic valve interventions, and should be assessed across different interventions, including emerging percutaneous techniques. The study aim was to assess the change in QOL after different procedures for aortic valve replacement (AVR). METHODS: QOL was assessed using the Short Form-36 questionnaire (SF-36) for 59 patients after conventional AVR; of these patients, 28 had AVR via a J-sternotomy, a transapical approach was used in 20 patients, and a transfemoral approach in 34. RESULTS: The early mortality during hospitalization was not significantly different among all four groups. The inverse probability weighted propensity scores adjusted Kaplan-Meier curve revealed that the transapical group had the lowest survival rate. The treatment effect analysis was most prominent in the transfemoral transcatheter aortic valve implantation (TAVI) group across all domains for QOL. The multivariate hierarchical linear mixed final fitted model shows that the transapical TAVI procedure and NYHA class (III-IV) had a significant negative effect on the physical domain and overall QOL score. CONCLUSION: Changes in QOL after interventions on the aortic valve were determined by the patient's preoperative status and the surgical intervention. The transcatheter intervention, even in 'sicker' patients, provided a gain in QOL comparable with that after an open-heart procedure. Transfemoral TAVI was shown to have advantages over transapical TAVI in terms of QOL improvement at three months and six months, and should be considered the first choice for patients in the high-risk surgical group.

Cost-effectiveness analysis of robot-assisted vs. open partial nephrectomy.

BACKGROUND: The cost-effectiveness of robot-assisted partial nephrectomy (RAPN) vs. the open procedure is not established. METHODS: We estimated in-hospital complications and the cost of RAPN vs. open partial nephrectomy (OPN) using an economic model. Costs incurred both intraoperatively and in hospital were considered. US data were extracted from existing literature. RESULTS: Mean in-hospital costs were $14,824 (95% CI $13,368-$16,898) for RAPN and $15,094 (95% CI $13,491-$17,140) for OPN. Complications after RAPN occurred in 23.3% (95% CI 20.0-25.8%) and after OPN in 36.1% (95% CI 35.6-36.6%) of the patients. In a sensitivity analysis, limited centre experience was associated with relevant increase in RAPN cost and consequently in low cost-effectiveness. CONCLUSIONS: In this economic model based on US data, RAPN resulted in nominally lower cost but fewer perioperative complications than OPN. RAPN was not cost-effective in less experienced centres.