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Relationship of Surgeon Experience and Outcomes of Surgery for Degenerative Mitral Valve Disease
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  • Sameh Yousef,
  • Makoto Mori,
  • Clancy Mullan,
  • Pranammya Dey,
  • saket singh,
  • Cornell Brooks,
  • Syed Usman Bin Mahmood,
  • Sabet Hashim,
  • Prashanth Vallabhajosyula,
  • Arnar Geirsson
Sameh Yousef
Yale School of Medicine
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Makoto Mori
Yale University School of Medicine
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Clancy Mullan
Yale School of Medicine
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Pranammya Dey
Yale School of Medicine
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saket singh
Yale University School of Medicine
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Cornell Brooks
Yale School of Medicine
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Syed Usman Bin Mahmood
Yale University School of Medicine
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Sabet Hashim
Hartford Hospital
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Prashanth Vallabhajosyula
Yale School of Medicine
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Arnar Geirsson
Yale University School of Medicine
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Abstract

Objective: To assess the impact of surgeon experience on the outcomes of degenerative mitral valve disease. Methods: We reviewed all patients who had surgery for degenerative mitral valve disease between 2011-2016. Experienced surgeon was defined as performing  25 mitral valve operations/year. Patient characteristics and outcomes were compared. Multivariable analysis was performed to identify factors associated with MR recurrence. Survival analysis for mortality was done using Kaplan Meier curve and Cox proportional Hazard method. Results: There were 575 patients treated by 9 surgeons for severe mitral regurgitation caused by degenerative mitral valve disease between 2011-2016. 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=0.001). Experienced surgeons were more likely to attempt repair (P=0.024), to succeed in repair (94.7% vs 87%, P=0.001), had shorter cross-clamp times (P=0.001), and achieved higher repair rate (81.3% vs 69.7%, P=0.005). Experienced surgeons were more likely to use neochordae (P=0.001) and less likely to use chordae transfer (P=0.001). Surgeon experience was not associated with recurrence (moderate or higher MR) within the first two years after surgery but was an independent risk factor for mortality (HR= 2.64, P=0.002). Conclusions: Techniques of degenerative mitral valve surgery differ with surgeon experience, with higher rates of repair and better outcomes associated with more experienced surgeons.

Peer review status:ACCEPTED

10 Dec 2020Submitted to Journal of Cardiac Surgery
11 Dec 2020Submission Checks Completed
11 Dec 2020Assigned to Editor
11 Dec 2020Reviewer(s) Assigned
14 Dec 2020Review(s) Completed, Editorial Evaluation Pending
14 Dec 2020Editorial Decision: Revise Major
02 Jan 20211st Revision Received
26 Feb 2021Submission Checks Completed
26 Feb 2021Assigned to Editor
27 Feb 2021Reviewer(s) Assigned
04 Mar 2021Review(s) Completed, Editorial Evaluation Pending
04 Mar 2021Editorial Decision: Accept