Valvular & structural heart disease
Mitral Valve Repair: Optimal Annual Case Volume for Surgery
Authors' conclusion
Our study validates volume cutoffs associated with optimal long-term outcomes following isolated MVr. We found MVr volumes of >38 cases/y, 45 cases/y, and >70 cases/y to be associated with significantly improved long-term survival, durability of repair, and freedom from reoperation, respectively. These findings may define experienced centers and surgeons for patients requiring MVr for primary/degenerative mitral valve disease.
Study context
- Population
- Adults undergoing isolated mitral valve repair (MVr) in contemporary studies, January 2013 to November 2023patients from 60 studies · Studies reporting long-term survival (16 studies) 6,099 · Studies reporting long-term freedom from reoperation (12 studies) 4,230 · Studies reporting Kaplan-Meier-derived freedom from recurrent mitral regurgitation (10 studies) 2,470
- Participants
- 14,070 adults
- Comparison
- Association between annual case volume and contemporary long-term outcomes of patients undergoing isolated MVr
- Outcome
- Long-term survival, freedom from reoperation, and freedom from recurrent mitral regurgitation (moderate-severe)
- Follow-up
- Long-term
Methodological detailssystematic literature search, frailty Cox model, studies divided into 3 tertiles (T1-3) based on annual case volume and number of patients of each center
- Systematic literature search
- Frailty Cox model
- Studies divided into 3 tertiles (T1-3) based on annual case volume and number of patients of each center
Pooled result
As reported in the abstract
Each group vs lower volume centersHazard ratio (95% CI)P value
Centers performing >38 cases/ylong-term survival
0.42(0.36–0.49)
P < 0.001Centers performing >45 cases/ylong-term freedom from recurrent mitral regurgitation
0.61(0.44–0.84)
P = 0.003>70 cases/yfreedom from reoperation
0.64(0.42–0.98)
P = 0.042- Overall pooled 10-year survival
- 70.8% (95% CI: 68.9%-72.8%)
- Overall pooled 10-year freedom from reoperation
- 90.2% (95% CI: 88.1%-92.4%)
- Overall pooled 10-year freedom from recurrent mitral regurgitation
- 72.7% (95% CI: 68.9%-76.8%)
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Degenerative mitral valve disease (subgroup): long-term survival, freedom from recurrent mitral regurgitation, freedom from reoperation>45 cases/yvs lower volume centersLong-term survival | 0.40 (0.32–0.49) | P < 0.001 | |
| Degenerative mitral valve disease (subgroup): long-term survival, freedom from recurrent mitral regurgitation, freedom from reoperation>45 cases/yvs lower volume centersFreedom from recurrent mitral regurgitation | 0.51 (0.36–0.72) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
- Degenerative mitral valve disease (subgroup): long-term survival, freedom from recurrent mitral regurgitation, freedom from reoperation — Volume outcome association for freedom from reoperation not statistically significant
- P = 0.58
Original publication
Mitral Valve Repair: Optimal Annual Case Volume for Surgery. JACC Adv. Published 10 February 2025. doi:10.
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