Valvular & structural heart disease
Defining centres of expertise for minimally invasive mitral valve surgery: a systematic review and volume–outcome meta-analysis
Authors' conclusion
The threshold to define a high-volume centre ranges between 53 and 60 cases/year based on repair rate, long-term survival and freedom-from reoperation. These findings have the potential to facilitate centralisation of MIMVS. PROSPERO registration number CRD42022376293.
Study context
- Population
- Consecutive patients undergoing minimally invasive mitral valve surgery (MIMVS); studies of transcatheter procedures excludedpatients from 68 unique centres
- Participants
- 23,495 patients
- Comparison
- Centre volume vs outcome in MIMVS
- Outcome
- Early mortality
Methodological detailspreregistered in PROSPERO, restricted cubic spline analyses, elbow method, reconstructed Kaplan-Meier curves, leave-one-out sensitivity analyses
- Preregistered in PROSPERO
- Restricted cubic spline analyses
- Elbow method
- Reconstructed Kaplan-Meier curves
- Leave-one-out sensitivity analyses
Pooled result
As reported in the abstract
Early mortality
1.3%
95% CI 1.1% to 1.6%
Further pooled results
Stroke
- No statistically significant non-linear volume-outcome relation
Mitral valve repair rate
- Statistically significant volume-outcome relation
- P = 0.018
- Threshold to define a high-volume centre
- 60 cases/year
- Number needed to treat to prevent a replacement
- ≤7
Long-term survival and freedom from reoperation
Cases/year
- Significant volume-outcome relation; threshold for long-term survival
- 53
- Threshold for freedom from reoperation
- 54
- Robust across the sensitivity analyses
Original publication
Defining centres of expertise for minimally invasive mitral valve surgery: a systematic review and volume–outcome meta-analysis. Heart. Published 10 May 2025. doi:10.
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