Abstract
Objective : To assess the impact of surgeon experience on the
outcomes of degenerative mitral valve disease.
Methods : We reviewed all patients who had surgery for
degenerative mitral valve disease between 2011-2016. Experienced surgeon
was defined as performing ≥ 25 mitral valve operations/year. Patient
characteristics and outcomes were compared. Multivariable analysis was
performed to identify factors associated with MR recurrence. Survival
analysis for mortality was done using Kaplan Meier curve and Cox
proportional Hazard method.
Results : There were 575 patients treated by 9 surgeons for
severe mitral regurgitation caused by degenerative mitral valve disease
between 2011-2016. Three experienced surgeons performed 77.2% of the
operations. Patients treated by less experienced surgeons had worse
comorbidity profile and were more likely to have an urgent or emergent
operation (P=0.001). Experienced surgeons were more likely to attempt
repair (P=0.024), to succeed in repair (94.7% vs 87%, P=0.001), had
shorter cross-clamp times (P=0.001), and achieved higher repair rate
(81.3% vs 69.7%, P=0.005). Experienced surgeons were more likely to
use neochordae (P=0.001) and less likely to use chordae transfer
(P=0.001). Surgeon experience was not associated with recurrence
(moderate or higher MR) within the first two years after surgery but was
an independent risk factor for mortality (HR= 2.64, P=0.002).
Conclusions :Â Techniques of degenerative mitral valve surgery
differ with surgeon experience, with higher rates of repair and better
outcomes associated with more experienced surgeons.
Keywords : Mitral valve surgery; Clinical outcomes; Degenerative
mitral valve disease; Surgeon experience