The effect of surgeon experience on the short-term outcomes of aortic annular enlargement

To determine whether surgeon case volume influences short-term outcomes after aortic annular enlargement (AAE).

From January 2019 to December 2023, 202 patients underwent isolated first-time aortic valve replacement with aortic annular enlargement by 11 surgeons. Two performed ≥25 AAEs per year (high case volume surgeons), whereas the other 9 performed <25 AAEs per year (low case volume surgeons). The short-term outcomes were compared between the high case volume surgeons (n = 126) and the low case volume surgeons (n = 76).

The groups were similar in age, sex, body surface area, and all measured preoperative comorbidities, including Society of Thoracic Surgeons Predicted Risk of Mortality scores. Preoperative aortic valve mean gradients and aortic valve areas did not significantly differ between the groups. The high case-volume surgeons implanted prostheses that were on average one size larger (size 27 vs size 25). All measured perioperative outcomes including operative mortality were not statistically different between groups. Kaplan-Meier estimation of survival at 4 years was 96.0% among the patients of the high case-volume surgeons and 92.5% among those of the low case-volume surgeons (P = .57). On follow-up echocardiography, patients of the high case-volume surgeons had lower aortic valve mean gradients (7 mm Hg vs 8 mm Hg, P = .005), larger aortic valve areas (2.2 cm² vs 1.9 cm², P = .039), and less patient-prosthesis mismatch (6.9% [5/72] vs 26% [11/43], P = .005).

AAE can be performed safely by surgeons with less experience with the procedure, but surgeons who perform AAE more frequently implant larger valves with better hemodynamics.