Surgical aortic valve replacement with a novel bovine pericardial tissue valve: a real world comparison of short-term costs and outcomes in US hospitals

Use of bioprosthetic tissue valves in surgical aortic valve replacement (SAVR) has increased in recent years. The effect of novel bovine pericardial tissue valves on short-term costs and utilization has not been established. We assessed INSPIRIS RESILIA aortic tissue valves (*Edwards Lifesciences, Irvine CA) during SAVR hospitalization and 90 days post-discharge compared to other tissue valves for all ages, and to mechanical valves for patients of shared decision-making age (50–65). Retrospective observational study using US hospital data. Adults admitted for first-time SAVR 2018–2021 with identifiable tissue or mechanical valves were analyzed. Outcomes were adjusted for demographics, comorbidities, procedure and hospital characteristics using generalized linear modeling. 20,125 patients were analyzed; majority were male, with elective procedures in academic hospitals. Compared to other tissue valves, length of stay and ICU stay were shorter with INSPIRIS (p < 0.001). In-hospital mortality was not statistically different. Readmissions at 30 days were 7.1% with INSPIRIS, 9.0% other tissue valves; 10.4% vs. 13.0% at 90 days (both p < 0.001). Reduced cost of readmission (-$1,013 at 90 days) partially offset the difference of $2,429 in initial hospitalization cost. INSPIRIS valves compared to mechanical valves (ages 50–65) showed similar patterns in utilization. In-hospital mortality was lower with INSPIRIS than mechanical valves (2.0% vs. 3.2%, p = 0.009), but did not differ when limited to isolated SAVR only. Initial hospitalization cost was higher for INSPIRIS ($7,079, p < 0.001), with lower 90-day readmissions cost (-$899, p < 0.05). Non-randomized analysis of real-world data. Patients undergoing SAVR with INSPIRIS valves had shorter length of stay and fewer readmissions compared to other tissue valves and to mechanical valves. Reduced cost of readmissions partially offset higher cost of initial SAVR admission. Further research is warranted to explore this association between valve used and utilization outcomes. This study looked at adults in the United States who had surgery to replace their diseased or worn-out aortic heart valve. Researchers compared outcomes for patients who received a newer type of valve named INSPIRIS RESILIA made from treated cow tissue to those who received other tissue valves or mechanical valves. Researchers wanted to know whether the INSPIRIS valve benefited patients in the short term within 90 days after surgery. The study used hospital billing data from a representative sample covering about a quarter of US hospitals. Researchers used advanced statistical methods and adjusted for differences in patient health, surgeon experience and hospital characteristics to ensure robust comparisons. However, some factors could not be measured due to limitations in the data. Patients who received the INSPIRIS valve generally discharged home, spent less time in the hospital and in the intensive care unit (ICU) compared to those with other tissue valves. They also had fewer hospital readmissions within 30 and 90 days after surgery. The study also looked at patients aged 50 to 65, a group where either tissue or mechanical valves may be used. Compared to mechanical valves, patients with INSPIRIS valves had lower in-hospital death rates, shorter ICU and hospital stays, and fewer hospital readmissions within 30 and 90 days. Overall, the INSPIRIS valve was associated with shorter hospital stays and fewer readmissions, which may benefit patients. The researchers propose that these observations should be studied further to see if these benefits are directly related to the INSPIRIS valve.