Our Summary

This study looks at the relationship between the number of operations a surgeon performs and the outcomes for patients who need mitral valve repairs. The researchers looked at all mitral repair cases at a hospital that performs a large number of these surgeries (an average of 192 per year) from 1992 to 2018. They divided the surgeons into two groups: those who performed 25 or more of these surgeries per year (high-volume surgeons) and those who performed fewer (low-volume surgeons).

They found that high-volume surgeons completed the surgeries a bit faster than low-volume surgeons, but there wasn’t a significant difference in patient survival, the need for additional surgeries, complications during surgery, or the length of hospital stay between the two groups. However, low-volume surgeons were more likely to have to switch from a repair to a replacement during the surgery.

In conclusion, the study suggests that the overall experience of a hospital in performing a large number of these surgeries may make up for an individual surgeon’s lower volume. However, for more complex cases, referring to high-volume surgeons could be beneficial as they have a lower rate of needing to switch from a repair to a replacement.

FAQs

  1. Does the number of surgeries a surgeon performs impact the outcomes for patients requiring mitral valve repairs?
  2. Is there a significant difference in patient survival, the need for additional surgeries, complications during surgery, or the length of hospital stay between high-volume and low-volume surgeons?
  3. Are low-volume surgeons more likely to switch from a repair to a replacement during the surgery?

Doctor’s Tip

Tip: When considering mitral valve repair, it may be beneficial to seek out a high-volume surgeon who has experience performing a large number of these surgeries per year. This may help reduce the likelihood of needing to switch from a repair to a replacement during surgery and potentially improve outcomes. Be sure to discuss your options with your doctor and consider seeking a second opinion if necessary.

Suitable For

Patients who are typically recommended for mitral valve repair are those with mitral valve regurgitation or stenosis, which can be caused by a variety of factors such as congenital heart defects, rheumatic heart disease, or degenerative changes in the valve. The decision to undergo mitral valve repair versus replacement depends on the severity of the condition, the patient’s overall health, and the experience of the surgical team.

Based on the findings of this study, patients who may benefit from being referred to high-volume surgeons for mitral valve repair include those with more complex cases or who may be at higher risk for complications during surgery. High-volume surgeons have been shown to have lower rates of having to switch from a repair to a replacement, which can impact the long-term outcomes for the patient. Additionally, high-volume surgeons may have more experience and expertise in performing these surgeries, leading to potentially better outcomes for the patient.

Timeline

Before mitral valve repair:

  1. Patient experiences symptoms such as shortness of breath, fatigue, chest pain, and heart palpitations.
  2. Patient undergoes diagnostic tests such as echocardiograms, electrocardiograms, and cardiac catheterization to determine the severity of the mitral valve issues.
  3. Patient consults with a cardiologist and cardiac surgeon to discuss treatment options, including mitral valve repair.
  4. Surgery is scheduled, and the patient undergoes pre-operative testing and preparation.

After mitral valve repair:

  1. Patient undergoes mitral valve repair surgery, which involves repairing the damaged valve to improve blood flow and heart function.
  2. Patient is closely monitored in the intensive care unit immediately after surgery.
  3. Patient undergoes a period of recovery in the hospital, where they receive post-operative care and rehabilitation.
  4. Patient is discharged from the hospital and continues recovery at home, following a prescribed medication regimen and attending follow-up appointments with their healthcare team.
  5. Patient gradually resumes normal activities and experiences improvements in symptoms such as increased energy levels and improved exercise tolerance.

What to Ask Your Doctor

Some questions a patient should ask their doctor about mitral valve repair include:

  1. How many mitral valve repair surgeries do you perform each year?
  2. What is your success rate with mitral valve repair surgeries?
  3. What are the potential risks and complications associated with mitral valve repair surgery?
  4. How long is the recovery period after mitral valve repair surgery?
  5. Are there any alternative treatment options to consider?
  6. Will I need to take any medication after the surgery?
  7. How often will I need follow-up appointments after the surgery?
  8. What lifestyle changes may be necessary after mitral valve repair surgery?
  9. What signs or symptoms should I watch for that may indicate a problem with the repaired valve?
  10. Are there any restrictions on physical activity or diet after mitral valve repair surgery?

Reference

Authors: Newell P, Percy E, Hirji S, Harloff M, McGurk S, Malarczyk A, Chowdhury M, Yazdchi F, Kaneko T. Journal: Ann Thorac Surg. 2023 Feb;115(2):412-419. doi: 10.1016/j.athoracsur.2022.05.057. Epub 2022 Jun 30. PMID: 35779603