Relationship of Surgeon Experience and Outcomes of Surgery for
Degenerative Mitral Valve Disease
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: Techniques of degenerative mitral valve surgery
differ with surgeon experience, with higher rates of repair and better
outcomes associated with more experienced surgeons.