Relation of Mitral Valve Surgery Volume to Repair Rate, Durability, and Survival

Abstract

This study suggests that individual surgeon volume is a determinant of not only mitral repair rates, but also freedom from reoperation, and survival. The data from this study support the guideline's concept of reference referral to experienced mitral surgeons to improve outcomes in patients with degenerative mitral valve disease.

Management of Asymptomatic Severe Degenerative Mitral Regurgitation

“…52 A recent New York State-wide multicenter study has shown that individual surgeons' mitral valve case volume has a significant impact on early-and long-term patients' outcomes after mitral valve surgery. 53 Failure in mitral valve repair. Surgeons capable of successful and durable MV repair are not universally available.…”

“…Surgeons capable of successful and durable MV repair are not universally available. 53,54 On average, a surgeon needs to perform at least 100 isolated mitral cases per year in order to have a repair rate of 83%. A total annual surgeon volume of <25 operations has been reported to be associated not only with lower mitral valve repair rates, but also with increased 1-year mortality and mitral valve reoperation rates.…”

“…A total annual surgeon volume of <25 operations has been reported to be associated not only with lower mitral valve repair rates, but also with increased 1-year mortality and mitral valve reoperation rates. 53 The inconvenient truth is that the median number of MV surgeries is five per surgeon per year in the United States, which is associated with a repair rate of 55%. 55 In the Society of Thoracic Surgeons registry, although the repair rate has improved steadily over the years, the replacement rate for isolated primary MR is still over 30% 56 and we are well aware that prosthesis at the mitral position is associated with suboptimal outcomes.…”

2019 AATS/ACC/ASE/SCAI/STS expert consensus systems of care document: A proposal to optimize care for patients with valvular heart disease

“…For most patients with severe primary MR, for example, it is well‐recognized that mitral valve repair is superior to mitral valve replacement . However, repair rates for primary MR vary significantly among individual surgeons and across institutions . Although repair rates for primary MR have increased, there remains concern that many patients with anatomy amenable to repair instead undergo valve replacement, with adverse downstream consequences related to LV dysfunction and the presence of valve prostheses.…”

“…Patients with severe primary MR may have complex valve pathology that makes durable surgical repair technically challenging, such as anterior leaflet or bileaflet disease, Barlow's disease, or extensive annular or subvalvular calcification. The decision to operate on an asymptomatic patient with severe primary MR and preserved LV and systolic function is complex and hinges critically on the likelihood of a successful, durable repair in the hands of an experienced mitral surgeon working in collaboration with intraoperative echocardiographic imaging experts . In addition, the successful management of atrial fibrillation at the time of mitral valve surgery may require comprehensive approaches to ablation that are not widely practiced.…”