Relationship among surgical volume, repair quality, and perioperative outcomes for repair of mitral insufficiency in a mitral valve reference center.
OBJECTIVE
Although it has been demonstrated that the repair rates and quality of the repair of mitral insufficiency are superior in mitral valve reference centers, it has not been studied whether an advantage exists for perioperative morbidity and mortality. We report 1 surgeon's evolution over 7 years, specifically considering the changes in perioperative morbidity and mortality.


METHODS
We performed a retrospective review of 1054 patients who had undergone elective, day-of-surgery-admission mitral valve repair by a single surgeon (D.H.A.) at our institution from April 2005 to June 2012. The outcome variables studied were operative mortality (30-day or in-hospital mortality, if longer), length of stay, low cardiac output state after cardiopulmonary bypass, and major morbidity.


RESULTS
The overall operative mortality was 0.58%. Of the 1054 patients, 31% developed a low cardiac output state postoperatively and 6.52% experienced at least 1 of the composite morbidity events. Increased aortic crossclamp times were significantly and independently associated with a low cardiac output state, length of stay, and morbidity. When divided by service year, a statistically and clinically significant decrease was found in the aortic crossclamp time, despite an increase in the complexity of cases. The morbidity decreased concurrently with the decreases in crossclamp times.


CONCLUSIONS
As the number of mitral valve repairs performed each year by a single surgeon at a single institution increased, morbidity, including postoperative heart function and length of stay, decreased. This was demonstrated to occur in large part from a reduction in the aortic crossclamp times, despite an increase in the complexity of the procedures. This further demonstrates the value of reference centers for mitral valve surgery.
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: menachem.weiner@mountsinai.org.
Menachem M
MM
Weiner
Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.
Ira
I
Hofer
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Hung-Mo
HM
Lin
Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Javier G
JG
Castillo
Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
David H
DH
Adams
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Gregory W
GW
Fischer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D002315:Cardiopulmonary Bypass / Q000592:standards; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D009519:New York City; D061646:Operative Time; D019984:Quality Indicators, Health Care / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult