Learning curve analysis of mitral valve repair using telemanipulative technology

Charland, Patrick J.; Robbins, Tom; Rodriguez, Evilio; Nifong, Wiley; Chitwood, Randolph

doi:10.1016/j.jtcvs.2010.10.029

Cited by 28 publications

(21 citation statements)

References 10 publications

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“…Use of clips instead of suture for mitral ring implantation was found to have a positive effect on total robotic time. As expected, we also found that with increased surgeon experience, the procedure complexity increased [45].…”

Section: Learning Curvessupporting

confidence: 86%

Robotic mitral valve surgery

et al. 2011

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Background: Robotic mitral valve surgery has evolved and matured into a safe and reproducible procedure at multiple worldwide centers of excellence.Methods: History of robotic mitral valve repair is reviewed. Current results and recent advances are discussed.Results: Multiple trials have demonstrated that surgical outcomes for robotic mitral valve repair meet or exceed the results of conventional operations, but longterm studies are required. Patients undergoing robotic mitral valve repair experience improved quality of life and faster return to full activity compared to sternotomy patients. Although operative costs may be higher than sternotomy procedures, total hospital costs may be equivalent and societal costs are probably reduced.Conclusions: Continued technological and procedural advances extend the benefits of robotic surgery to a larger patient population.

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Section: Learning Curvessupporting

confidence: 86%

Robotic mitral valve surgery

et al. 2011

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“…The percentage of patients who required mitral valve reoperation during follow-up has been described in detail in previous publications from our institution, with reoperation rates that are within the range of results published for full sternotomy mitral valve surgery. 2,3,13 However, these studies come from high-volume centers with vast experience in MIS-MV surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Surgeons at other centers might be reluctant to adopt the minimally invasive approach because of the initial learning curve involved. Although several publications have discussed the learning curve associated with MIS-MV operations, [3][4][5] such publications are expert opinion only with few supportive data.…”

Section: Inimally Invasive Surgery Of the Mitral Valve (Mis-mv)mentioning

confidence: 99%

Learning Minimally Invasive Mitral Valve Surgery

et al. 2013

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Background-Learning curves are vigorously discussed and viewed as a negative aspect of adopting new procedures.However, very few publications have methodically examined learning curves in cardiac surgery, which could lead to a better understanding and a more meaningful discussion of their consequences. The purpose of this study was to assess the learning process involved in the performance of minimally invasive surgery of the mitral valve using data from a large, single-center experience. Methods and Results-All mitral (including tricuspid, or atrial fibrillation ablation) operations performed over a 17-year period through a right lateral mini-thoracotomy with peripheral cannulation for cardiopulmonary bypass (n=3907) were analyzed. Data were obtained from a prospective database. Individual learning curves for operation time and complication rates (using sequential probability cumulative sum failure analysis) and average results were calculated. A total of 3895 operations by 17 surgeons performing their first minimally invasive surgery of the mitral valve operation at our institution could be evaluated. The typical number of operations to overcome the learning curve was between 75 and 125. Furthermore, >1 such operation per week was necessary to maintain good results. Individual learning curves varied markedly, proving the need for good monitoring or mentoring in the initial phase. Data were drawn from a prospectively gathered database for MIS-MV housed at our institution. The study was approved for anonymous analysis by the institutional review board, with additional patient consent waived. Conclusions Patient Selection and Surgical TechniqueIt is the policy at our institution to use the MIS-MV approach whenever possible. The main reasons for not using minimally invasive procedures were previous right thoracotomy with expected lung adhesions, difficulties with femoral vessel cannulation, and in the case or urgent or emergent surgery, the unavailability of a surgeon versed in the MIS-MV approach. Other possible reasons for preferring the sternotomy approach were a very low ejection fraction (to achieve the shortest possible cross-clamp time) and expected difficulties with valve replacement because of extremely severe annular calcification or deep annular abscess. Such decisions were made at the surgeon's discretion.In all patients who underwent an MIS-MV, a right-lateral minithoracotomy and femoral cannulation for cardiopulmonary bypass with mild to moderate hypothermia were performed. In the vast majority of patients, a transthoracic aortic clamp as introduced by Chitwood et al 8 was used. Details on the MIS-MV operative approach are described more thoroughly elsewhere. 2,9 Patients who underwent robotic mitral valve surgery were excluded. Data AnalysisCategorical variables are expressed as proportions and continuous variables as mean±SD throughout this study. Patients were divided into groups of 50 consecutive operations to evaluate the influence of growing surgical experience on adverse outcomes. Testing for ...

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“…Charland et al [26] investigated LCs for mitral valve repairs using telemanipulation technology and found a statistically significant LC (p < 0.01) and learning percentage of 95% for safe operation using the technology.…”

Section: Valve Implantation/valve Surgerymentioning

confidence: 99%

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Arora

Khan

Abboudi

et al. 2014

Postgraduate Medicine

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LCs in cardiothoracic and vascular procedures are hugely variable depending on the procedure type, outcome measures, level of prior experience, and methods/statistics used. Uniformity in methods, variables, and statistical analysis is needed to derive meaningful comparisons of LCs. Acknowledgment and application of learning processes other than those reliant on volume-outcomes relationship will benefit LC research and training of surgeons.

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Learning curve analysis of mitral valve repair using telemanipulative technology

Cited by 28 publications

References 10 publications

Robotic mitral valve surgery

Robotic mitral valve surgery

Learning Minimally Invasive Mitral Valve Surgery

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

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