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.