Key result
High-volume surgeons linked to ~45% higher odds of mitral valve repair vs lower-volume surgeons.
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Why the study?
The relative influence of surgeon- versus center-level mitral valve repair volume on repair utilization and early outcomes in primary mitral regurgitation was unclear.
Does high surgeon or center volume improve mitral valve repair utilization in adults undergoing isolated surgery for primary mitral regurgitation?
Observational (n=6,649)
Yes
Does high surgeon or center volume improve mitral valve repair utilization in adults undergoing isolated surgery for primary mitral regurgitation?
Odds Ratio: 1.45 (95% CI 1.1–1.9)
Absolute Event Rate: 93% vs 70%
p-value: p=0.003
Surgeon-level volume is a stronger predictor of successful mitral valve repair and shorter operative times than center-level volume for patients with primary mitral regurgitation.
Surgeon volume was associated with higher repair rates; leaves open whether center volume or referral patterns drive outcomes in primary MR.
OBJECTIVE: To evaluate the relative influence of surgeon- and center-level mitral valve repair volume with repair utilization and early outcomes among adults undergoing isolated surgery for primary mitral regurgitation. METHODS: Using the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (March 2011- March 2025), we identified adults undergoing isolated mitral valve surgery for primary mitral regurgitation. High-volume centers (>50 repairs annually) and high-volume surgeons (>25 repair over two consecutive years) were identified. The primary outcome was mitral valve repair versus replacement. Secondary outcomes included operative times and selected early postoperative outcomes. RESULTS: Among 6,649 mitral valve surgery patients, the repair rate was 80% (n = 5,329). Only 3 (9%) of 33 centers and 6 (3.8%) of 146 surgeons were high-volume. High-volume centers had higher observed repair rates (87%, n = 3,027 vs 73%, n = 2,302), non-significant after adjustment (odd ratios: 1.23, 95% confidence interval: 0.61-2.45; p = .56). High-volume surgeons had higher adjusted repair rates (93%, n = 2,613 vs 70%, n = 2,716; odd ratio (95% confidence interval): 1.45(1.1-1.9), p = .003), shorter median cross-clamp times (75 min, interquartile range (55-111) vs 91 min, (71-117), p = .001), and had lower permanent pacemaker implantation rates (1.0%, vs 3.0%, p < .001). CONCLUSIONS: In contradistinction to high-volume, higher surgeon-level mitral repair volume remained associated with greater repair utilization. Moreover, high vs low volume surgeons had shorter operative times, and fewer selected early postoperative complications.
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Caruso et al. (2026) conducted an observational in Primary mitral regurgitation (n=6,649). High-volume surgeon (>25 repairs over two consecutive years) vs. Low-volume surgeon was evaluated on Mitral valve repair versus replacement (OR 1.45, 95% CI 1.1-1.9, p=0.003). High-volume surgeons were associated with higher adjusted rates of mitral valve repair compared to lower-volume surgeons (93% vs 70%; OR 1.45; 95% CI 1.1-1.9; P=0.003).
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