Surgeon Versus Center Volume as Determinants of Mitral Valve Repair Rates Outcomes: Insights From a Statewide Review

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Thoracic and Cardiovascular Surgery

Abstract

Objective: To evaluate the impact of center and surgeon volume on mitral valve repair (MVr) rates and outcomes in primary degenerative mitral valve (PD-MV) disease to identify quality improvement (QI) opportunities. Methods: We analyzed patients with PD-MV undergoing surgery at 33 centers (2011–2025) in the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. High-volume centers were defined as>50 MVr/ year; high-volume surgeons as>25 MVr/year for ≥2 years. The primary endpoint was MVr versus replacement utilization. Secondary outcomes included 30-day mortality, operative times, and repair strategies. Risk-adjusted comparisons used generalized estimating equation models. Results: Of 6,649 patients, 80% (n=5,329) underwent MVr. Three centers (9%; median 760, IQR 404–1863) and 6 surgeons (3.8%; median 228, IQR 220–238) met high-volume criteria; medians for low-volume centers and surgeons were 109 (IQR 52–215) and 36 (IQR 18–112). High-volume centers achieved higher unadjusted MVr rates (87%, n=3,027 vs 73%, n=2,302; p=0.01), although this was not significant after adjustment (OR 1.8, 95% CI 0.65–5.1, p=0.24). High-volume surgeons achieved markedly higher MVr rates (93%, n=2,613 vs 70%, n=2,716; OR 1.9, 95% CI 1.4–2.4, p< 0.001). Thirty-day mortality was similar (1.2%, n=43 vs 1.7%, n=54; OR 1.1, 95% CI 0.8–1.6, p=0.444). Median cross-clamp times were shorter for high-volume surgeons (75 min, IQR 55–111 vs 91, IQR 71–117; p=0.001). Advanced repair strategies were also more frequent, including triangular resection (73%, n=1,089 vs 51%, n=679; p=0.001) and chordal replacement (17%, n=477 vs 15%, n=582; p=0.001). High-volume surgeons demonstrated lower risk-adjusted odds of prolonged ventilation (OR 0.75, 95% CI 0.5–0.9; p=0.005) and reoperation (OR 0.7, 95% CI 0.5–0.97; p=0.037). Permanent pacemaker requirement was also reduced (1.3%, n=52 vs 3.3%, n=92; p< 0.001). Conclusions: Center volume did not independently predict MVr utilization or outcomes. In contrast, high-volume surgeons achieved higher repair rates, shorter operative times, broader adoption of advanced repair techniques, and lower rates of prolonged ventilation and permanent pacemaker. Surgeon-specific experience appears central to optimizing outcomes and supports QI initiatives aimed at increasing repair adoption among lower-volume surgeons.

Volume

171

Issue

4 Suppl 1

First Page

S142

Last Page

S143

Comments

American Association for Thoracic Surgery (AATS) 106th Annual Meeting, May 2-5, 2026, Chicago, IL

DOI

10.1016/j.jtcvs.2026.03.495

Link to Full Text

Share

COinS