Heart Valve Replacement Cost

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[1] , 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[2] in New Hampshire charges about $86,500, including doctor fee, after a 30% uninsured discount. St. Mary's Hospital[3] 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[4] , complications occurred about 35%of the time and caused significantly longer hospital stays and increased charges. Complications of aortic valve replacement[5] or mitral valve replacement[6] range from infection to heart or lung problems such as irregular heart rhythms, heart attack or heart failure or pneumonia.

• In heart valve replacement surgery[7] , 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[8] , followed by the mitral valve[9] . It is less common for the tricuspid valve[10] or the pulmonary valve[11] to be replaced.
• Recovery[12] 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.

• 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[13] 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.

• Many hospitals give discounts of up to 30% or more to uninsured/cash-paying patients. For example, Washington Hospital Healthcare System[14] in California offers a 35% discount.

• A cardiologist can provide a referral to a cardiothoracic surgeon. Or, the CardioThoracic Surgery Network offers a state-by-state surgeon locator[15] . 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[16] 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[17] of different types of replacement valves.

1.  circ.ahajournals.org/content/123/4/e18.full.pdf
2.  patients.dartmouth-hitchcock.org/billing_questions/out_of_pocket_estimator_dhmc.html
3.  www.wipricepoint.org/Basic_INP.aspx
4.  www.ncbi.nlm.nih.gov/pubmed/17505440
5.  heart.emedtv.com/aortic-valve-replacement/aortic-valve-replacement-complications.html
6.  heart.emedtv.com/mitral-valve-replacement/mitral-valve-replacement-complications-p...
7.  www.nlm.nih.gov/medlineplus/ency/article/002954.htm
8.  www.nlm.nih.gov/medlineplus/ency/article/007408.htm
9.  www.nlm.nih.gov/medlineplus/ency/article/007412.htm
10.  my.clevelandclinic.org/heart/disorders/valve/tricuspid.aspx
11.  www.mayoclinic.org/pulmonary-valve-disease/treatment.html
12.  my.clevelandclinic.org/heart/disorders/recovery_ohs.aspx
13.  healthonline.washington.edu/document/health_online/pdf/Physical_Therapy_After_Card...
14.  www.whhs.com/about/washington-hospital-discount-policy-for-uninsured/
15.  www.ctsnet.org/members/bystate.cfm?ms=surgeons&o=sts
16.  www.columbiasurgery.org/aortic/faqs_surgeons.html
17.  www.umm.edu/heart/aortic_valve_replace.htm

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