loading page

Mitral valve repair rates in degenerative mitral valve disease correlate with surgeon and hospital procedural volume
  • +1
  • Stephanie Wayne,
  • Catherine Martin,
  • Julian Smith,
  • Aubrey Almeida
Stephanie Wayne
Monash Health

Corresponding Author:[email protected]

Author Profile
Catherine Martin
Monash University
Author Profile
Julian Smith
Monash Health
Author Profile
Aubrey Almeida
Monash Health
Author Profile


Study aim: To determine the relationship between surgeon and hospital procedural volume, and mitral valve repair rates and 30-day mortality for degenerative mitral regurgitation (MR), in Australian cardiac surgical centres. Methods: 4,970 patients who underwent surgery for degenerative MR between January 2008 and December 2017 in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) Database were retrospectively included. Univariate and multivariate regression analyses examined surgeon and hospital procedural volumes for associations with repair rate and mortality. Results: Repair rates varied widely by caseload; from 56.7% to 80.4% for lowest to highest volume surgeons; and from 52.0% to 76.1% for lowest to highest volume hospitals. Compared to surgeons performing ≤5 procedures/annum, surgeons performing 10.1-20/annum were more likely to repair the valve (OR 2.91, 95% Confidence Interval [CI] 1.50-5.64, p=0.002), particularly if performing >20/annum (OR 3.9, 95% CI 1.62-9.37, p=0.002). Compared to hospitals performing ≤10/annum, those performing any number of procedures >10 demonstrated increased likelihood of repair (caseload 10.1-20/year OR 2.04, 95% CI 1.30-3.20, p=0.002) though odds did not increase above this threshold. Low incidence of 30-day mortality (83 of 4,964, 1.67%) limited analysis of contributing variables; procedural volume did not confer a survival benefit, though mortality rates were lowest for highest volume proceduralists and hospitals. Conclusions: Surgeon and hospital caseload were significantly associated with repair rates of degenerative MR. A threshold minimum of 10 procedures annually for surgeons and hospitals should be utilised to maximise repair rates, and ideally of 20 for surgeons. Mortality was low and may not be significantly impacted by procedural volume.
14 Aug 2020Submitted to Journal of Cardiac Surgery
14 Aug 2020Submission Checks Completed
14 Aug 2020Assigned to Editor
22 Aug 2020Reviewer(s) Assigned
24 Aug 2020Review(s) Completed, Editorial Evaluation Pending
27 Aug 2020Editorial Decision: Revise Major
26 Sep 20201st Revision Received
13 Oct 2020Assigned to Editor
13 Oct 2020Submission Checks Completed
13 Oct 2020Reviewer(s) Assigned
16 Oct 2020Review(s) Completed, Editorial Evaluation Pending
17 Oct 2020Editorial Decision: Revise Minor
13 Nov 20202nd Revision Received
16 Nov 2020Submission Checks Completed
16 Nov 2020Assigned to Editor
17 Nov 2020Reviewer(s) Assigned
17 Nov 2020Review(s) Completed, Editorial Evaluation Pending
19 Nov 2020Editorial Decision: Accept
Apr 2021Published in Journal of Cardiac Surgery volume 36 issue 4 on pages 1419-1426. 10.1111/jocs.15310