Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
Division of Cardiac Surgery, Hartford Health Care, Hartford, Connecticut, USA.
J Card Surg. 2021 Aug;36(8):2621-2627. doi: 10.1111/jocs.15583. Epub 2021 Apr 24.
To assess the impact of surgeon experience on the outcomes of degenerative mitral valve disease.
We reviewed all patients who had surgery for degenerative mitral valve disease between 2011 and 2016. Experienced surgeon was defined as performing ≥ 25 mitral valve operations/year. Patient characteristics and outcomes were compared. Competing risk analysis was performed to identify factors associated with mitral regurgitation (MR) recurrence. Survival analysis for mortality was done using Kaplan Meier curve and Cox proportional hazard method.
There were 575 patients treated by 9 surgeons for severe MR caused by degenerative mitral valve disease between 2011 and 2016. Three experienced surgeons performed 77.2% of the operations. Patients treated by less experienced surgeons had worse comorbidity profile and were more likely to have an urgent or emergent operation (p = .001). Experienced surgeons were more likely to attempt repair (p = .024), to succeed in repair (94.7% vs. 87%; p = .001), had shorter cross-clamp times (p = .001), and achieved higher repair rate (81.3% vs. 69.7%; p = .005). Experienced surgeons were more likely to use neochordae (p = .001) and less likely to use chordae transfer (p = .001). Surgeon experience was not associated with recurrence of moderate or higher degree of MR after repair but was an independent risk factor for mortality (HR = 2.64; p = .002).
Techniques of degenerative mitral valve surgery differ with surgeon experience, with higher rates of repair and better outcomes associated with more experienced surgeons.
评估外科医生经验对退行性二尖瓣疾病治疗结果的影响。
我们回顾了 2011 年至 2016 年间因退行性二尖瓣疾病接受手术的所有患者。经验丰富的外科医生定义为每年行二尖瓣手术≥25 例。比较患者特征和结局。采用竞争风险分析确定与二尖瓣反流（MR）复发相关的因素。使用 Kaplan-Meier 曲线和 Cox 比例风险法进行死亡率的生存分析。
2011 年至 2016 年间，9 位外科医生为 575 例因退行性二尖瓣疾病导致严重 MR 的患者进行了治疗。其中 3 位经验丰富的外科医生完成了 77.2%的手术。由经验较少的外科医生治疗的患者合并症情况更差，更有可能进行紧急或急诊手术（p=0.001）。经验丰富的外科医生更倾向于尝试修复（p=0.024），修复成功率更高（94.7% vs. 87%；p=0.001），体外循环时间更短（p=0.001），修复成功率更高（81.3% vs. 69.7%；p=0.005）。经验丰富的外科医生更倾向于使用人工腱索（p=0.001），而不太倾向于使用腱索转移（p=0.001）。外科医生经验与修复后中度或更严重程度的 MR 复发无关，但与死亡率独立相关（HR=2.64；p=0.002）。
退行性二尖瓣手术技术因外科医生经验而异，经验丰富的外科医生修复率更高，结局更好。
