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Impact of Mitral Valve Repair Case Volume on Postoperative Mortality　- A Nationwide Korean Cohort Study

Karam Nam1, Eun Jin Jang2, Jun Woo Jo3

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine.

Circulation Journal : Official Journal of the Japanese Circulation Society
|August 4, 2020
PubMed

Insights

Higher mitral valve repair volume in hospitals is linked to better patient survival. Centers performing fewer repairs had significantly higher 1-year mortality rates, suggesting a need for volume standards.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Surgical Outcomes

Background:

  • Mitral valve repair is preferred over replacement due to superior patient outcomes.
  • Significant variations exist in mitral valve repair rates across different medical centers.
  • This study investigates the impact of institutional surgical volume on mitral valve repair outcomes.

Purpose of the Study:

  • To determine the association between hospital mitral valve repair volume and postoperative mortality.
  • To analyze the effect of case volume on 1-year and cumulative all-cause mortality.
  • To evaluate whether a minimum volume standard is necessary for optimal surgical outcomes.

Main Methods:

  • Analysis of 6,041 adult mitral valve repair cases in Korea (2009-2016).
  • Centers categorized into low (<20), medium (20-40), and high (>40) annual repair volumes.
  • Statistical analysis of 1-year mortality and cumulative all-cause mortality in relation to center volume.

Main Results:

  • 1-year mortality rates were 10.1% (low), 8.7% (medium), and 4.7% (high-volume centers).
  • Low- and medium-volume centers showed significantly increased odds of 1-year mortality (OR 2.80 and 2.66, respectively) compared to high-volume centers.
  • Higher cumulative all-cause mortality was observed in low- and medium-volume centers (HR 1.96 and 1.77, respectively).

Conclusions:

  • Lower institutional case volume for mitral valve repair is associated with increased patient mortality.
  • Establishing minimum volume standards for hospitals performing mitral valve repair may improve patient outcomes.
  • Surgical volume is a critical factor influencing the success of mitral valve repair procedures.
Abstract

Keywords:
Case volumeMitral valve repairOutcomes

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