 | With Health Insurance: Copays and 10%-50% Coinsurance |
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 | Without Health Insurance: $80,000-$200,000+ |
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| Heart valve replacement involves replacing a diseased valve in the heart -- most commonly, the aortic valve -- with a new valve taken either from another part of the patient's heart, or made from human or animal tissue, or man-made materials. Risks include reaction to anesthesia, infection, bleeding, blood clots, stroke, heart attack and death. | | |
| Typical costs: | - For patients covered by health insurance, out-of-pocket costs typically consist of doctor visit copays, prescription drug copays and coinsurance of 10%-50% or more, which probably would reach the yearly out-of-pocket maximum. Valve replacement surgery typically is covered by health insurance.
- For patients not covered by health insurance, valve replacement surgery typically costs from about $80,000 -$200,000 or more with an average, according to an American Heart Association report, of $164,238, not including the doctor fee. A surgeon fee can add $5,000 or more to the final bill. For example, Dartmouth-Hitchcock Medical Center in New Hampshire charges about $86,500, including doctor fee, after a 30% uninsured discount. St. Mary's Hospital in Wisconsin charges an average of $107,000, but costs can reach $200,000 or more. And Baptist Memorial Health Care charges about $75,000 -$140,000, not including doctor fee, but cost can go up to more than $200,000 with major complications.
- According to a study published in the Journal of Cardiovascular Surgery, complications occurred about 35%of the time and caused significantly longer hospital stays and increased charges. Complications of aortic valve replacement or mitral valve replacement range from infection to heart or lung problems such as irregular heart rhythms, heart attack or heart failure or pneumonia.
What should be included: | - In heart valve replacement surgery, the patient is placed under general anesthesia and connected to a heart-lung bypass machine that performs the work of the heart. The surgeon will either make a large incision in the chest -- or, for minimally invasive surgery, a smaller one -- and will cut away the diseased valve and attach a new one.
- The valve most commonly replaced is the aortic valve, followed by the mitral valve. It is less common for the tricuspid valve or the pulmonary valve to be replaced.
- Recovery requires a hospital stay of at least five to seven days -- and sometimes up to two weeks or longer -- as well as six to eight weeks off from work.
Additional costs: | - A patient must go to the dentist before surgery and have any necessary dental work done to prevent oral bacteria from causing an infection in the new valve.
- Patients typically require one or more sessions of physical therapy to learn how to move without harming the incision and to learn exercises to assist recovery. This typically costs $50 -$350 per session. The University of Washington Medical Center Cardiac Surgery Clinic offers information on physical therapy after heart surgery.
- Patients who have a mechanical (man-made) valve inserted must take a blood thinning medication such as warfarin (brand name Coumadin), or possibly Plavix, for life. At Drugstore.com, Warfarin typically costs about $15 -$25 per month, depending on dose, for the generic or $50 -$70 for the brand name, and Plavix costs about $200 or more per month.
Discounts: | |
Shopping for heart valve replacement: | - A cardiologist can provide a referral to a cardiothoracic surgeon. Or, the CardioThoracic Surgery Network offers a state-by-state surgeon locator. A cardiothoracic surgeon should be certified by the American Board of Thoracic Surgery and should have completed a general surgery residency and a residency in cardiothoracic surgery.
- Columbia University Medical Center lists questions to ask the surgeon about heart valve surgery. It is important to ask about all options for a replacement valve, because each type has different risks and follow-up care requirements. The Maryland Heart Center at the University of Maryland Medical Center offers a primer on the pros and cons of different types of replacement valves.
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Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
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Article updated February 2012 |
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