When is your surgeon good enough? When do you need a "referent surgeon"?
Recent American College of Cardiology/American Heart Association guidelines recommend mitral valve repair in asymptomatic patients at an experienced center, assuming the likelihood for repair is > or = 90%. This has raised the question of how you define an experienced center (or surgeon). This article describes thoughts on the criteria that should make up a Center of Excellence: surgical training; intraoperative echocardiography; high volume; cardiology involvement; audit of clinical outcomes and outcomes of repair; and associated surgery for atrial fibrillation and tricuspid regurgitation. High-volume programs (> or = 140 mitral valve operations per year) have the lowest mortality and highest repair rate. Although some pathologic conditions may be repaired with a high degree of certainty by experienced (nonreferent) surgeons, considerable variation still exists. Recent publications of repair rates and outcomes using minimally invasive surgery and conventional surgery highlight this variability.
McCarthy
Patrick M
PM
Division of Cardiothoracic Surgery, Northwestern University, 201 East Huron Street, Chicago, IL 60611-2968, USA. pmccart@nmh.org
D002300:Cardiac Care Facilities / Q000592:standards; D002309:Cardiology / Q000592:standards*; D013504:Cardiovascular Surgical Procedures / Q000592:standards*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States