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Learning curve predictors for minimally invasive mitral valve surgery; how far should the rabbit hole go?
Aleksander Dokollari1, Matteo Cameli2, Didar-Karan S Kalra3
1Cardiac Surgery Division, Saint Michael's Hospital, Toronto, Ontario, Canada.
Objective:
To analyze predictors that influence the learning curve of minimally invasive mitral valve surgery (MIMVS).
Methods:
Patients who underwent MIMVS between March 2010 to March 2015 were retrospectively analyzed. Predictive factors that influence the learning curve were analyzed.
Results:
One hundred and five patients were included in the analysis. Cardiopulmonary bypass (CPB) time in minutes was 158.72 ± 40.98 and the aortic cross-clamp (ACC) time in minutes was 114.48 ± 27.29. There were three operative mortalities, one stroke and five >2+ mitral regurgitation. ACC time in minutes was higher in the low logistic Euroscore II (LES) group (LES < 5% = 118.42 ± 27.94) versus (LES ≥ 5 = 88.66 ± 22.26), P < .05 while creatinine clearance in μmol/L was higher in the LES < 5% group (LES < 5% = 84.32 ± 33.7) versus (LES ≥ 5% = 41.66 ± 17.14), (P < .05). One patient from each group required chest tube insertion for pleural effusion P < .05. The cumulative sum analysis (CUSUM) for the first 25 patients had CPB and ACC times that reached the upper limits. Between 25 to 64 patients the curve remained stable while with the introduction of reoperations and complex surgical procedures the CUSUM reached the upper limits.
Conclusions:
The learning curve is affected by many factors but this should not desist surgeons from approaching this technique. The introduction of high-risk patients in clinical practice should be carefully measured based on surgeon experience.
Insights
The learning curve for minimally invasive mitral valve surgery (MIMVS) is influenced by various factors, including patient risk and surgical complexity. Surgeons should carefully assess experience before operating on high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Minimally invasive mitral valve surgery (MIMVS) offers potential benefits but involves a learning curve for surgeons.
- Understanding predictors of this learning curve is crucial for safe adoption and improved patient outcomes.
Purpose of the Study:
- To identify and analyze the key factors influencing the learning curve associated with minimally invasive mitral valve surgery (MIMVS).
Main Methods:
- Retrospective analysis of 105 patients who underwent MIMVS between March 2010 and March 2015.
- Evaluation of predictive factors impacting surgical outcomes and operative times.
Main Results:
- Cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times were analyzed, with ACC time significantly higher in lower logistic Euroscore II (LES) groups.
- Creatinine clearance was also higher in the lower LES group.
- Cumulative sum (CUSUM) analysis indicated initial challenges in the first 25 patients, followed by stabilization, and then increases with reoperations and complex procedures.
Conclusions:
- The learning curve for MIMVS is multifactorial, influenced by patient selection and surgical complexity.
- Surgeons should cautiously approach high-risk patients, tailoring case selection to their accumulated experience.
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