Introduction
Degenerative mitral valve disease is the most common valvular pathology worldwide, affecting up to 10% of adults aged 75 years and over [1]. The Valvular Heart Disease Guidelines of both the European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) and the American College of Cardiology (ACC)/American Heart Association (AHA) recommend that mitral valve repair as the preferred technique over mitral valve replacement for severe primary mitral regurgitation (MR), where a durable and successful repair is expected [2, 3]. Additionally, where ventricular function is preserved and the patient is asymptomatic, the aforementioned guidelines stipulate that surgery should only take place in centres specialising in valve surgery, where the expectation of durable repair is high and mortality is low [2, 3]. A strong inverse relationship is known to exist for many procedures between surgeon volume and mortality [4] and hospital volume and mortality [5]. Similar findings have been observed in studies based on United States (US) data [6-9]. However, no Australasian study has examined the relationship between surgeon and hospital volume and mitral valve repair rates and mortality for degenerative MR.
It is therefore the purpose of this investigation to ascertain whether, in an Australian cohort, a relationship exists between hospital and surgeon procedural volume and mitral valve repair rates and 30-day mortality. Excluding other pathologies such as valve stenosis which adversely affect propensity for repair, the authors sought to identify the effect of this “modifiable” variable of procedural volume on patient outcomes. In our low-density Australian population the feasibility of establishing “heart valve centres” may be limited. Nonetheless, we sought to come up with a recommendation regarding annual procedural volume for hospitals and surgeons to maximise repair rates and minimise operative mortality.