Importance of surgeon's experience in practicing valve-sparing aortic root replacement

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Valve-sparing root replacement (VSRR) is a complex procedure requiring specialized surgical skills.
• Surgeon procedural volume is a potential factor influencing the adoption and outcomes of VSRR.

Purpose of the Study:

• To investigate the association between surgeon's annual aortic root replacement (ARR) volume and the utilization of VSRR.
• To compare the long-term outcomes, including survival and reoperation rates, for VSRR performed by surgeons with different procedural volumes.

Main Methods:

• Retrospective analysis of 1697 patients undergoing ARR at high-volume aortic centers.
• Surgeons classified into low (<5 ARR/year) and high (≥5 ARR/year) volume groups.
• Multivariable logistic regression and inverse probability treatment weighting (IPTW) used for analysis.

Main Results:

• Higher surgeon volume (≥5 ARR/year) was independently associated with a greater likelihood of performing VSRR (OR 3.33).
• Despite lower VSRR utilization by low-volume surgeons, IPTW analysis showed no significant differences in long-term survival (P=.59) or aortic valve reoperation rates (P=.60) after VSRR.
• 92% of VSRR procedures were performed by high-volume surgeons.

Conclusions:

• In high-volume centers, surgeons with lower annual aortic root replacement volume are less likely to perform VSRR.
• Valve-sparing root replacement can be performed safely by surgeons with lower procedural volumes, yielding comparable long-term results.