Key result
Undergoing mitral valve repair at low-volume centers (<20 cases/year) was associated with a significantly higher 1-year mortality compared to high-volume centers (>40 cases/year) (10.1% vs 4.7%, OR 2.80).
Why the study?
Mitral valve repair is recommended over replacement due to better outcomes, but repair rates vary significantly among centers.
Does performing mitral valve repair in high-volume centers reduce postoperative mortality in adult patients compared to low- or medium-volume centers?
Cohort (n=6,041)
Yes
Does performing mitral valve repair in high-volume centers reduce postoperative mortality in adult patients compared to low- or medium-volume centers?
Odds Ratio: 2.8 (95% CI 2.15–3.64)
Absolute Event Rate: 10.1% vs 4.7%
p-value: p=<0.001
Higher institutional case volume (>40 cases/year) for mitral valve repair is significantly associated with lower 1-year and cumulative all-cause mortality compared to lower volume centers.
May warrant referral caution to higher-volume centers; leaves open specific volume thresholds for guidelines.
BACKGROUND: Although mitral valve repair is recommended over replacement due to better outcomes, repair rates vary significantly among centers. This study examined the effect of institutional mitral valve repair volume on postoperative mortality. METHODS AND RESULTS: All cases of adult mitral valve repair performed in Korea between 2009 and 2016 were analyzed. The association between case volume and 1-year mortality was analyzed after categorizing centers according to the number of mitral valve repairs performed as low-, medium-, or high-volume centers (<20, 20-40, and >40 cases/year, respectively). The effect of case volume on cumulative all-cause mortality was also assessed. In all, 6,041 mitral valve repairs were performed in 86 centers. The 1-year mortality in low-, medium-, and high-volume centers was 10.1%, 8.7%, and 4.7%, respectively. Low- and medium-volume centers had increased risk of 1-year mortality compared with high-volume centers, with odds ratios of 2.80 (95% confidence interval [CI] 2.15-3.64; P<0.001) and 2.66 (95% CI 1.94-3.64; P<0.001), respectively. The risk of cumulative all-cause mortality was also worse in low- and medium-volume centers, with hazard ratios of 1.96 (95% CI 1.68-2.29; P<0.001) and 1.77 (95% CI 1.47-2.12; P<0.001), respectively. CONCLUSIONS: Lower institutional case volume was associated with higher mortality after mitral valve repair. A minimum volume standard may be required for hospitals performing mitral valve repair to guarantee adequate outcome.
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Nam et al. (2020) conducted a cohort in Mitral valve repair (n=6,041). Low institutional case volume (<20 cases/year) vs. High institutional case volume (>40 cases/year) was evaluated on 1-year mortality (OR 2.80, 95% CI 2.15-3.64, p=<0.001). Undergoing mitral valve repair at low-volume centers (<20 cases/year) was associated with a significantly higher 1-year mortality compared to high-volume centers (>40 cases/year) (10.1% vs 4.7%, OR 2.80).
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