Stephanie Wayne

and 3 more

Study aim: To determine the relationship between surgeon and hospital procedural volume, and mitral valve repair rates and 30-day mortality for degenerative mitral regurgitation (MR), in Australian cardiac surgical centres. Methods: 4,970 patients who underwent surgery for degenerative MR between January 2008 and December 2017 in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) Database were retrospectively included. Univariate and multivariate regression analyses examined surgeon and hospital procedural volumes for associations with repair rate and mortality. Results: Repair rates varied widely by caseload; from 56.7% to 80.4% for lowest to highest volume surgeons; and from 52.0% to 76.1% for lowest to highest volume hospitals. Compared to surgeons performing ≤5 procedures/annum, surgeons performing 10.1-20/annum were more likely to repair the valve (OR 2.91, 95% Confidence Interval [CI] 1.50-5.64, p=0.002), particularly if performing >20/annum (OR 3.9, 95% CI 1.62-9.37, p=0.002). Compared to hospitals performing ≤10/annum, those performing any number of procedures >10 demonstrated increased likelihood of repair (caseload 10.1-20/year OR 2.04, 95% CI 1.30-3.20, p=0.002) though odds did not increase above this threshold. Low incidence of 30-day mortality (83 of 4,964, 1.67%) limited analysis of contributing variables; procedural volume did not confer a survival benefit, though mortality rates were lowest for highest volume proceduralists and hospitals. Conclusions: Surgeon and hospital caseload were significantly associated with repair rates of degenerative MR. A threshold minimum of 10 procedures annually for surgeons and hospitals should be utilised to maximise repair rates, and ideally of 20 for surgeons. Mortality was low and may not be significantly impacted by procedural volume.