The study’s senior author, David H. Adams, MD, with lead author Joanna Chikwe, MD.
Researchers at the Icahn School of Medicine at Mount Sinai have found that patients who undergo mitral valve operations with surgeons who perform more than 25 such procedures annually experience lower one-year mortality and reoperation rates when compared to individuals treated by surgeons who do fewer procedures. Significantly, those high-volume surgeons also were more likely to perform a valve repair—the preferred treatment that offers important clinical advantages, such as better life expectancy and quality of life—over a valve replacement with a mechanical or animal valve.
The findings were presented recently at the American Association for Thoracic Surgery Centennial meeting and simultaneously published online by the Journal of the American College of Cardiology.
In a normal heart, mitral valve leaflets open and close with each heartbeat to allow blood to flow in one direction from the upper collection chamber to the lower pumping chamber. In degenerative mitral valve disease, one or both leaflets prolapse, leading to the backward flow of blood (mitral valve regurgitation).
In the study, Mount Sinai researchers analyzed adult patients who underwent mitral valve surgery in New York State between 2002 and 2013—a population that included a cohort of 5,475 patients with degenerative disease—comparing repair rates, reoperations within 12 months of repair, and survival, based on total annual surgeon volume. In all, 313 surgeons from 41 institutions met the study’s criteria.
The findings showed that among surgeons who performed any mitral valve procedures, the median volume was 10 cases per year, with a mean valve repair rate of 55 percent. In the subgroup of patients with degenerative disease, the mean repair rate ranged from 77 percent for surgeons with total annual volumes of more than 51 cases, to 48 percent for surgeons who performed fewer than 10 cases. Other key results showed that surgeons who performed 25 or more surgeries annually had reoperation rates at 1.3 percent compared to 3.6 percent for surgeons doing fewer surgeries. Additionally, survival improved for every 10 additional cases.
“Our findings add further clarity to the American Heart Association and American College of Cardiology guidelines that already recognize that patients with degenerative mitral valve disease should be referred to experienced mitral surgeons whenever feasible,” says the study’s senior author, David H. Adams, MD, Cardiac Surgeon-in-Chief of the Mount Sinai Health System, and the Marie-Josée and Henry R. Kravis Professor and Chair of the Department of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai. “This is the first study to link individual surgeon volume to survival and freedom from reoperation at one year in patients undergoing operations for degenerative mitral valve disease.”
The study’s lead author, Joanna Chikwe, MD, Clinical Professor of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and Professor of Surgery, Chief of Cardiothoracic Surgery, and Co-Director of the Heart Institute at Stony Brook School of Medicine, notes, “Considering that there was an incremental improvement in survival and probability of repair with increasing volume over 25 operations, one could make the argument that a minimum volume target of 50, or even more, annual operations would be optimal and particularly beneficial in patients with complex but repairable mitral valve disease.”