Rf39. Surgeon Versus Center Volume as Determinants of Mitral Valve Repair Rates and Outcomes: Insights from a Statewide Review

Document Type

Conference Proceeding

Publication Date

5-1-2026

Publication Title

J Thorac Cardiovasc Surg

Keywords

adult, artificial heart pacemaker, cohort analysis, complication, conference abstract, controlled study, cross clamp time, female, high volume surgeon, human, low volume surgeon, major clinical study, male, middle aged, mitral valve, mitral valve repair, mortality, operation duration, reoperation, retrospective study, surgeon, surgery, therapy, total quality management, wedge resection

Abstract

Objective: To evaluate the impact of center and surgeon volume on mitral valve repair (MVr) rates and outcomes in primary degenerative mitral valve (PD-MV) disease to identify quality improvement (QI) opportunities. Methods: We analyzed patients with PD-MV undergoing surgery at 33 centers (2011–2025) in the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. High-volume centers were defined as >50 MVr/year; high-volume surgeons as >25 MVr/year for ≥2 years. The primary endpoint was MVr versus replacement utilization. Secondary outcomes included 30-day mortality, operative times, and repair strategies. Risk-adjusted comparisons used generalized estimating equation models. Results: Of 6,649 patients, 80% (n=5,329) underwent MVr. Three centers (9%; median 760, IQR 404–1863) and 6 surgeons (3.8%; median 228, IQR 220–238) met high-volume criteria; medians for low-volume centers and surgeons were 109 (IQR 52–215) and 36 (IQR 18–112). High-volume centers achieved higher unadjusted MVr rates (87%, n=3,027 vs 73%, n=2,302; p=0.01), although this was not significant after adjustment (OR 1.8, 95% CI 0.65–5.1, p=0.24). High-volume surgeons achieved markedly higher MVr rates (93%, n=2,613 vs 70%, n=2,716; OR 1.9, 95% CI 1.4–2.4, p<0.001). Thirty-day mortality was similar (1.2%, n=43 vs 1.7%, n=54; OR 1.1, 95% CI 0.8–1.6, p=0.444). Median cross-clamp times were shorter for high-volume surgeons (75 min, IQR 55–111 vs 91, IQR 71–117; p=0.001). Advanced repair strategies were also more frequent, including triangular resection (73%, n=1,089 vs 51%, n=679; p=0.001) and chordal replacement (17%, n=477 vs 15%, n=582; p=0.001). High-volume surgeons demonstrated lower risk-adjusted odds of prolonged ventilation (OR 0.75, 95% CI 0.5–0.9; p=0.005) and reoperation (OR 0.7, 95% CI 0.5–0.97; p=0.037). Permanent pacemaker requirement was also reduced (1.3%, n=52 vs 3.3%, n=92; p<0.001). Conclusions: Center volume did not independently predict MVr utilization or outcomes. In contrast, high-volume surgeons achieved higher repair rates, shorter operative times, broader adoption of advanced repair techniques, and lower rates of prolonged ventilation and permanent pacemaker. Surgeon-specific experience appears central to optimizing outcomes and supports QI initiatives aimed at increasing repair adoption among lower-volume surgeons. ADULT CARDIAC: Mitral and Tricuspid Valve

Volume

171

Issue

4

First Page

S142

Last Page

S143

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