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Review
. 2022 Oct;37(10):3290-3299.
doi: 10.1111/jocs.16783. Epub 2022 Jul 21.

In a large-volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes

Joel C Boudreaux  1 , Marian Urban  2 , Anthony W Castleberry  2 , John Y Um  2 , Michael J Moulton  2 , Aleem Siddique  2
Affiliations
Review

In a large-volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes

Joel C Boudreaux et al. J Card Surg. 2022 Oct.

Abstract

Background: In complex operations surgeon volume may impact outcomes. We sought to understand if individual surgeon volume affects left ventricular assist device (LVAD) outcomes.

Methods: We reviewed primary LVAD implants at an experienced ventricular assist devices (VAD)/transplant center between 2013 and 2019. Cases were dichotomized into a high-volume group (surgeons averaging 11 or more LVAD cases per year), and a low-volume group (10 or less per year). Propensity score matching was performed. Survival to discharge, 1-year survival, and incidence of major adverse events were compared between the low- and high-volume groups. Predictors of survival were identified with multivariate analysis.

Results: There were 315 patients who met inclusion criteria-45 in the low-volume group, 270 in the high-volume group. There was no difference in survival to hospital discharge between the low (91.9%) and high (83.3%) volume matched groups (p = .22). Survival at 1-year was also similar (85.4% vs. 80.6%, p = .55). There was no difference in the incidence of major adverse events between the groups. Predictors of mortality in the first year included: age (hazards ratio [HR]: 1.061, p < .001), prior sternotomy (HR: 1.991, p = .01), increasing international normalized ratio (HR: 4.748, p < .001), increasing AST (HR: 1.001, p < .001), increasing bilirubin (HR: 1.081, p = .01), and preoperative mechanical ventilation (HR: 2.662, p = .005). Individual surgeon volume was not an independent predictor of discharge or 1-year survival.

Conclusion: There was no difference in survival or adverse events between high and low volume surgeons suggesting that, in an experienced multidisciplinary setting, low-volume VAD surgeons can achieve similar outcomes to their high-volume colleagues.

Keywords: circulatory support; heart failure; ventricular assist device.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Annual case volume by surgeon, LVAD, left ventricular assist device.
Figure 2
Figure 2
Covariate balance between matched and unmatched groups
Figure 3
Figure 3
(A) One‐year survival of unmatched patients, (B) One‐year survival of matched patients
See this image and copyright information in PMC

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