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. 2022 Aug 11;9(8):261.
doi: 10.3390/jcdd9080261.

At the Crossroads of Minimally Invasive Mitral Valve Surgery-Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

Riccardo Cocchieri  1 , Bertus van de Wetering  2 , Sjoerd van Tuijl  2 , Iman Mousavi  3 , Robert Riezebos  4 , Bastian de Mol  5   6
Affiliations

At the Crossroads of Minimally Invasive Mitral Valve Surgery-Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

Riccardo Cocchieri et al. J Cardiovasc Dev Dis. .

Abstract

Almost 30 years after the first endoscopic mitral valve repair, Minimally Invasive Mitral Valve Surgery (MIMVS) has become the standard at many institutions due to optimal clinical results and fast recovery. The question that arises is can already good results be further improved by an Institutional Risk Management Performance (IRMP) system in decreasing risks in minimally invasive mitral valve surgery (MIMVS)? As of yet, there are no reports on IRMP and learning systems in the literature. (2) Methods: We described and appraised our five-year single institutional experience with MIMVS in isolated valve surgery included in the Netherlands Heart Registry (NHR) and investigated root causes of high-impact complications. (3) Results: The 120-day and 12-month mortality were 1.1% and 1.9%, respectively, compared to the average of 4.3% and 5.3% reported in the NHR. The regurgitation rate was 1.4% compared to 5.2% nationwide. The few high-impact complications appeared not to be preventable. (4) Discussion: In MIMVS, freedom from major and minor complications is a strong indicator of an effective IRMP but remains concealed from physicians and patients, despite its relevance to shared decision making. Innovation adds to the complexity of MIMVS and challenges surgical competence. An IRMP system may detect and control new risks earlier. (5) Conclusion: An IRMP system contributes to an effective reduction of risks, pain and discomfort; provides relevant input for shared decision making; and warrants the safe introduction of new technology. Crossroads conclusions: investment in machine learning and AI for an effective IRMP system is recommended and the roles for commanding and operating surgeons should be considered.

Keywords: minimally invasive mitral valve surgery; risk management; risk management methods; simulator training; surgical training.

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Conflict of interest statement

R.C., R.R. and I.M. are working at the OLVG hospital, where data to support the current study was obtained. The authors declare no further conflict of interest.

Figures

Figure 1
Figure 1
Comparison between the OLVG preoperative mean EuroSCORE II vs. other Dutch hospitals.
Figure 2
Figure 2
After thawing, the human cadaver heart is embalmed with a specialized solution of a very low toxicity. This embalmment ensures preservation, safe and user-friendly handling of the heart and tools and improves tissue quality, which allows for physiologic load of the heart, although protection measures always remain in place. Frame 1. provides an external view of the embalmed human cadaver heart. Frame 2. shows a TEE of the pulsating heart with an assessment of the diameter of the mitral valve diameter, the association with the aortic valve and length of chordae. Frame 3. presents a still of the videoscopic presentation of the left ventricle and partial left atrium.
Figure 2
Figure 2
After thawing, the human cadaver heart is embalmed with a specialized solution of a very low toxicity. This embalmment ensures preservation, safe and user-friendly handling of the heart and tools and improves tissue quality, which allows for physiologic load of the heart, although protection measures always remain in place. Frame 1. provides an external view of the embalmed human cadaver heart. Frame 2. shows a TEE of the pulsating heart with an assessment of the diameter of the mitral valve diameter, the association with the aortic valve and length of chordae. Frame 3. presents a still of the videoscopic presentation of the left ventricle and partial left atrium.
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