title: When is your surgeon good enough? When do you need a "referent surgeon"?
abstract: 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.
authors.affiliation: Division of Cardiothoracic Surgery, Northwestern University, 201 East Huron Street, Chicago, IL 60611-2968, USA. pmccart@nmh.org
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
mesh_terms: 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