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Efird JT, Griffin WF, Gudimella P, O'Neal WT, Davies SW, Crane PB, Anderson EJ, Kindell LC, Landrine H, O'Neal JB, Alwair H, Kypson AP, Nifong WL, Chitwood WR. Conditional long-term survival following minimally invasive robotic mitral valve repair: a health services perspective. Ann Cardiothorac Surg 2015; 4:433-42. [PMID: 26539348 DOI: 10.3978/j.issn.2225-319x.2015.08.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Conditional survival is defined as the probability of surviving an additional number of years beyond that already survived. The aim of this study was to compute conditional survival in patients who received a robotically assisted, minimally invasive mitral valve repair procedure (RMVP). METHODS Patients who received RMVP with annuloplasty band from May 2000 through April 2011 were included. A 5- and 10-year conditional survival model was computed using a multivariable product-limit method. RESULTS Non-smoking men (≤65 years) who presented in sinus rhythm had a 96% probability of surviving at least 10 years if they survived their first year following surgery. In contrast, recent female smokers (>65 years) with preoperative atrial fibrillation only had an 11% probability of surviving beyond 10 years if alive after one year post-surgery. CONCLUSIONS In the context of an increasingly managed healthcare environment, conditional survival provides useful information for patients needing to make important treatment decisions, physicians seeking to select patients most likely to benefit long-term following RMVP, and hospital administrators needing to comparatively assess the life-course economic value of high-tech surgical procedures.
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Affiliation(s)
- Jimmy T Efird
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - William F Griffin
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Preeti Gudimella
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Wesley T O'Neal
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen W Davies
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Patricia B Crane
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ethan J Anderson
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Linda C Kindell
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hope Landrine
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jason B O'Neal
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hazaim Alwair
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alan P Kypson
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Wiley L Nifong
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Randolph Chitwood
- 1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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