When is your surgeon good enough? When do you need a "referent surgeon"?

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes

Background:

• Recent guidelines recommend mitral valve repair for asymptomatic patients at experienced centers.
• Defining criteria for an "experienced center" remains a challenge.

Purpose of the Study:

• To outline essential criteria for establishing a Center of Excellence for mitral valve repair.
• To address the variability in repair rates and outcomes.

Main Methods:

• Discussion of key elements: surgical training, intraoperative echocardiography, high patient volume, cardiology collaboration, and outcome audits.
• Analysis of associated procedures like atrial fibrillation and tricuspid regurgitation surgery.
• Review of published repair rates and outcomes for both minimally invasive and conventional surgery.

Main Results:

• High-volume mitral valve programs (≥140 operations/year) are associated with the lowest mortality and highest repair rates.
• Significant variation in surgical repair rates and outcomes persists among centers and surgeons.
• Minimally invasive and conventional surgery outcomes highlight existing variability.

Conclusions:

• A comprehensive approach including specific training, technology, volume, and multidisciplinary collaboration is vital for mitral valve repair Centers of Excellence.
• Standardizing criteria can help ensure consistent, high-quality patient care and optimal repair outcomes.