Surgeon Versus Center Mitral Repair Volume and Repair Utilization in Primary Mitral Regurgitation: A Statewide Quality Collaborative Analysis.

Abstract

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. 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. 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). 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.