Key result
Operating surgeon predicts a ~250% higher odds of receiving a large prosthesis during AVR.
Why the study?
The impact of the operating surgeon on the selection of prosthesis size in aortic valve replacement was unclear.
Does the operating surgeon influence the selection of prosthesis size in patients undergoing aortic valve replacement?
Observational (n=748)
Does the operating surgeon influence the selection of prosthesis size in patients undergoing aortic valve replacement?
Odds Ratio: 3.5
Absolute Event Rate: 67.9% vs 24.5%
p-value: p=<0.0001
The choice of operating surgeon significantly impacts the size of the prosthesis selected during aortic valve replacement, independent of patient demographics or clinical profile.
Surgeon identity dominates prosthesis sizing in AVR beyond patient factors; leaves open standardization needs and outcome effects.
A retrospective analysis was performed to determine the surgeon's impact on the selection of the size of prosthesis in aortic valve replacement. From January 1993 through December 1997, 748 patients underwent either isolated aortic valve replacement (530) or double valve replacement (218) with bileaflet valves. Depending on the operating surgeon, patients were divided into group A (367) or group B (381). Preoperative, intraoperative, and postoperative variables in both groups were compared. Groups A and B were identical in demographic and clinical profiles. Cardiopulmonary bypass time, ischemic time, and early and late results in both groups were similar. Significantly more patients undergoing isolated aortic valve replacement in group A (169; 67.9%) received a large (≥25 mm) prosthesis compared with group B (69; 24.5%). Compared with group B, a large prosthesis was used in a significantly greater proportion of all patients in group A, irrespective of etiology, predominant aortic valve lesion, and age of the patient. Overall, the operating surgeon was identified as the most important predictor (odds ratio 3.5; p < 0.0001) of use of a large valve.
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Choudhary et al. (2000) conducted an observational in Aortic valve replacement (n=748). Operating surgeon (Group A) vs. Operating surgeon (Group B) was evaluated on Use of a large (≥25 mm) prosthesis (OR 3.5, p=<0.0001). The operating surgeon was the most important predictor of using a large (≥25 mm) prosthesis during aortic valve replacement (OR 3.5; p<0.0001), with rates of 67.9% vs 24.5% between surgeon groups.
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