Key result
Totally thoracoscopic mitral valve replacement improves operative times and perioperative outcomes after ~40 cases.
Why the study?
The learning curve of totally thoracoscopic mitral valve replacement and quantitative guidance for surgeons to perform the operation step by step were not well defined.
How many cases are required to master totally thoracoscopic mitral valve replacement and improve surgical outcomes?
Cohort (n=100)
No
How many cases are required to master totally thoracoscopic mitral valve replacement and improve surgical outcomes?
The learning curve for totally thoracoscopic mitral valve replacement requires approximately 40 cases to reach proficiency, after which surgical and perioperative outcomes significantly improve.
Answers are grounded in this paper and cite their sources.
Anticipate initial proficiency challenges with thoracoscopic mitral replacement; hypothesis-generating for multicenter training validation.
BACKGROUND: To investigate and analyze the learning curve of totally thoracoscopic mitral valve replacement and provide a quantitative reference for cardiac surgeons to carry out the operation step by step. METHODS: The clinical data were retrospectively analyzed of 100 consecutive patients with totally thoracoscopic mitral valve replacement successively performed by the same surgeon in a single center from May 2019 to June 2020. The learning curve was divided into 2 stages by using cumulative sum analysis, and relevant surgical parameters and perioperative indicators were analyzed. RESULTS: The first stage of the learning curve is the skill acquisition stage, which includes 1 to 40 surgical procedures. The second stage is the proficiency stage, involving 41 to 100 operations. Among the surgical parameters of the patients in the 2 stages, detectable improvements were observed in operative time, cardiopulmonary bypass time, cross-clamp time, and intraoperative injury. After surgery, the amount of drainage, length of hospital stay, blood creatinine levels, and oxygenation index 24 h after surgery were also significantly different between the 2 groups (all P < .05). The age and sex distributions of the patients were balanced, and there was no statistically significant difference in terms of conversion to median sternotomy between the 2 stages (P > .05). CONCLUSIONS: Cumulative sum analysis was used to accurately analyze the learning curve of totally thoracoscopic mitral valve replacement, indicating that 40 cases are needed to master the technique.
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Fang et al. (2021) conducted a cohort in Mitral valve disease requiring replacement (n=100). Totally thoracoscopic mitral valve replacement (proficiency stage, cases 41-100) vs. Skill acquisition stage (cases 1-40) was evaluated on Surgical parameters and perioperative indicators (operative time, cardiopulmonary bypass time, cross-clamp time, intraoperative injury, drainage, length of stay, etc.) (p=<.05). Totally thoracoscopic mitral valve replacement required 40 cases to master, with significant improvements in operative times and perioperative outcomes in subsequent cases (all P < .05).
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