Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA.
Ann Thorac Surg. 2010 Dec;90(6):1904-11; discussion 1912. doi: 10.1016/j.athoracsur.2010.07.062.
Mitral valve repair is acknowledged as desirable and superior to replacement for virtually all mitral pathology. Utilizing The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD), a multivariable model was created that included patient clinical characteristics and surgeon-specific mitral volume to predict the likelihood of mitral valve repair.
Between January 2005 and December 2007, 28,507 patients undergoing isolated mitral valve surgery (with or without tricuspid valve surgery, with or without atrial fibrillation surgery) by 1,088 surgeons at 639 hospitals in the STS ACSD were identified. Patient characteristics independently associated with mitral valve repair were identified using a generalized estimating equations logistic regression model. Observed mitral valve repair rates were plotted against surgeon-specific annual mitral volume, and predicted probabilities of mitral repair by surgeon volume were calculated after adjusting for patient baseline covariates.
On average, patients undergoing mitral valve surgery were 62 years old, with 51% female and 82% Caucasian. Among surgeons performing mitral procedures, the mean rate of mitral valve repair was 41% (range, 0% to 100%) and the median number of mitral valve operations per year was 5 (range, 1 to 166). Several patient characteristics were independently associated with a decreased odds of mitral repair (versus replacement), including mitral stenosis (odds ratio 0.09; 95% confidence interval: 0.08 to 0.11) and active endocarditis (odds ratio 0.21; 95% confidence interval: 0.17 to 0.25). While substantial variability in repair rates was observed among low-volume surgeons, increased surgeon-level mitral volume was independently associated with an increased probability of mitral repair.
This analysis demonstrates marked variability in the frequency of mitral valve repair, and the influence of both patient- and surgeon-level factors on the likelihood of mitral valve repair. Increasing surgeon-specific annual mitral valve volume is associated with a higher probability of mitral repair. Identification of these predictors of mitral valve repair creates substantial opportunity for quality improvement in patient outcomes in mitral valve surgery, potentially through education, adoption of best practices, and improved mitral repair enabling technology.
二尖瓣修复被认为是理想的，并且优于几乎所有二尖瓣病变的置换。利用胸外科医生学会（STS）成人心脏手术数据库（ACSD），创建了一个多变量模型，该模型包括患者的临床特征和外科医生特异性二尖瓣容量，以预测二尖瓣修复的可能性。
在 2005 年 1 月至 2007 年 12 月期间，在 STS ACSD 中，由 639 家医院的 1088 名外科医生对 28507 名接受单纯二尖瓣手术（伴或不伴三尖瓣手术，伴或不伴房颤手术）的患者进行了识别。使用广义估计方程逻辑回归模型确定与二尖瓣修复独立相关的患者特征。根据外科医生特定的年度二尖瓣容量绘制观察到的二尖瓣修复率，并在调整患者基线协变量后计算外科医生体积的二尖瓣修复预测概率。
平均而言，接受二尖瓣手术的患者年龄为 62 岁，女性占 51%，白种人占 82%。在进行二尖瓣手术的外科医生中，二尖瓣修复的平均比率为 41%（范围为 0%至 100%），每年二尖瓣手术的中位数为 5 例（范围为 1 例至 166 例）。几个患者特征与二尖瓣修复的可能性降低独立相关（与置换相比），包括二尖瓣狭窄（比值比 0.09；95%置信区间：0.08 至 0.11）和活动性心内膜炎（比值比 0.21；95%置信区间：0.17 至 0.25）。虽然低容量外科医生之间的修复率存在很大差异，但外科医生水平的二尖瓣体积增加与二尖瓣修复的可能性增加独立相关。
这项分析表明，二尖瓣修复的频率存在明显差异，并且患者和外科医生水平的因素都对二尖瓣修复的可能性有影响。增加外科医生特异性的年度二尖瓣瓣叶容量与更高的二尖瓣修复概率相关。确定这些二尖瓣修复的预测因素为二尖瓣手术患者的治疗结果提供了巨大的质量改进机会，可能通过教育、最佳实践的采用以及改进的二尖瓣修复技术。
