{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T17:49:27Z","timestamp":1778780967766,"version":"3.51.4"},"reference-count":23,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>There is no definitive consensus about the cost-effectiveness of minimally invasive aortic valve replacement (AVR) (MI-AVR) compared to conventional AVR (C-AVR). The aim of this study was to compare the rate of postoperative complications and total hospital costs of MI-AVR versus C-AVR overall and by the type of aortic prosthesis (biological or mechanical). Our single-center retrospective study included 324 patients over 18 years old who underwent elective isolated primary AVR with standard stented AV prosthesis at the Institute for Cardiovascular Diseases \u201cDedinje\u201d between January 2019 and December 2019. Reintervention, emergencies, combined surgical interventions, and patients with sutureless valves were excluded. In both MI-AVR and C-AVR, mechanical valve implantation contributed to overall reduction of hospital costs with equal efficacy. The cost-effectiveness ratio indicated that C-AVR is cheaper and yielded a better clinical outcome with mechanical valve implantation (67.17 vs. 69.5). In biological valve implantation, MI-AVR was superior. MI-AVR patients had statistically significantly higher LVEF and a lower Euro SCORE than C-AVR patients (Mann\u2013Whitney U-test, p = 0.002 and p = 0.002, respectively). There is a slight advantage to MI-AVR vs. C-AVR, since it costs EUR 9.44 more to address complications that may arise. Complications (mortality, early reoperation, cerebrovascular insult, pacemaker implantation, atrial fibrillation, AV block, systemic inflammatory response syndrome, wound infection) were less frequent in the MI-AVR, making MI-AVR more economically justified than C-AVR (18% vs. 22.1%).<\/jats:p>","DOI":"10.3390\/ijerph20032553","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:29:03Z","timestamp":1675218543000},"page":"2553","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Economic Justification Analysis of Minimally Invasive versus Conventional Aortic Valve Replacement"],"prefix":"10.3390","volume":"20","author":[{"given":"Marko","family":"Jovanovic","sequence":"first","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor","family":"Zivkovic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milos","family":"Jovanovic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8860-229X","authenticated-orcid":false,"given":"Ilija","family":"Bilbija","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-8449","authenticated-orcid":false,"given":"Masa","family":"Petrovic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jovan","family":"Markovic","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7846-1366","authenticated-orcid":false,"given":"Ivana","family":"Radovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Transfusiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Dimitrijevic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Soldatovic","sequence":"additional","affiliation":[{"name":"Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref_1","first-page":"S1","article-title":"The joint task force on the management of valvular heart disease of the European Society of cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Vahanian","year":"2012","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1093\/ejcts\/ezr204","article-title":"Contemporary outcomes of conventional aortic valve replacement in 638 octogenarians: Insights from an Italian Regional Cardiac Surgery Registry (RERIC)","volume":"41","author":"Fortuna","year":"2012","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jtcvs.2008.08.015","article-title":"Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: Changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database","volume":"137","author":"Brown","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"29","DOI":"10.14503\/THIJ-16-5852","article-title":"Transcatheter aortic valve replacement: Comprehensive review and present status","volume":"44","author":"Arora","year":"2017","journal-title":"Texas Heart Inst. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1093\/eurheartj\/ehq339","article-title":"Transcatheter aortic valve implantation: First results from a multi-centre real-world registry","volume":"32","author":"Zahn","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1093\/ejcts\/ezv038","article-title":"A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy: A propensity score analysis of 492 patients","volume":"49","author":"Bowdish","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1111\/jocs.14053","article-title":"The role of ministernotomy in aortic valve surgery\u2014A prospective randomized study","volume":"34","author":"Vukovic","year":"2019","journal-title":"J. Card. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e041398","DOI":"10.1136\/bmjopen-2020-041398","article-title":"Mini-sternotomy versus conventional sternotomy for aortic valve replacement: A randomised controlled trial","volume":"11","author":"Hancock","year":"2021","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.hlc.2011.10.004","article-title":"Right minithoracotomy versus full sternotomy for the aortic valve replacement:Preliminary results","volume":"21","author":"Sansone","year":"2012","journal-title":"Hear Lung Circ."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1016\/j.jtcvs.2015.01.014","article-title":"Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis","volume":"149","author":"Ghanta","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","first-page":"213","article-title":"Ministernotomy or sternotomy in isolated aortic valve replacement? Early results","volume":"15","author":"Filip","year":"2018","journal-title":"Kardiochir Torakochirurgia Pol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1016\/S0003-4975(98)00655-9","article-title":"\u201cJ\u201d incision minimal-access valve operations","volume":"66","author":"Svensson","year":"1998","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/S1010-7940(99)00119-0","article-title":"Less invasive aortic valve surgery: Rationale and technique","volume":"15","author":"Westaby","year":"1999","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_14","unstructured":"Rajput, F.A., and Zeltser, R. (2022). StatPearls [Internet], StatPearls Publishing."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/01.sla.0000137141.55267.47","article-title":"One thousand minimally invasive valve operations: Early and late results","volume":"240","author":"Mihaljevic","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.athoracsur.2010.03.055","article-title":"Aortic valve replacement surgery: Comparison of outcomes in matched sternotomy and PORT ACCESS groups","volume":"90","author":"Brinkman","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.jtcvs.2008.08.010","article-title":"Ministernotomy versus conventional sternotomy for aortic valve replacement: A systematic review and meta-analysis","volume":"137","author":"Brown","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1001\/jama.2010.1446","article-title":"Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial","volume":"304","author":"Hajjar","year":"2010","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.jtcvs.2012.12.041","article-title":"Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery","volume":"145","author":"LaPar","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2544","DOI":"10.1161\/CIRCULATIONAHA.107.698977","article-title":"Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery","volume":"116","author":"Murphy","year":"2007","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/00000658-199710000-00003","article-title":"Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair","volume":"226","author":"Cohn","year":"1997","journal-title":"Ann. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/S0003-4975(98)00300-2","article-title":"Minimally invasive valve operations","volume":"65","author":"Cosgrove","year":"1998","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.jtcvs.2011.12.008","article-title":"Outcomes of less invasive J-incision approach to aortic valve surgery","volume":"144","author":"Johnston","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2553\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:19:47Z","timestamp":1760120387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2553"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,31]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20032553"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20032553","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,31]]}}}