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. 2024 Jul 25:21:19-34.
doi: 10.1016/j.xjon.2024.07.013. eCollection 2024 Oct.

Importance of surgeon's experience in practicing valve-sparing aortic root replacement

Kavya Rajesh  1 , Megan Chung  1 , Dov Levine  1 , Elizabeth Norton  2 , Parth Patel  2 , Yu Hohri  1 , Chris He  2 , Paridhi Agarwal  2 , Yanling Zhao  3 , Pengchen Wang  3 , Paul Kurlansky  3 , Edward Chen  4 , Hiroo Takayama  1
Affiliations

Importance of surgeon's experience in practicing valve-sparing aortic root replacement

Kavya Rajesh et al. JTCVS Open. .

Abstract

Background: Valve-sparing root replacement (VSRR) requires a unique skill set. This study aimed to examine the influence of surgeon's procedural volume on outcomes of VSRR.

Methods: This retrospective study included 1697 patients from 2 large, high-volume aortic centers who underwent aortic root replacement (ARR) between 2004 and 2021 and were potentially eligible for VSRR. Surgeons were classified as performing <5 ARRs or ≥5 ARRs annually. Multivariable logistic regression was used to examine the independent association of surgeon volume and the decision to perform VSRR. Inverse probability treatment weighting (IPTW) was used to match patients who were operated on by <5 ARR surgeons or ≥5 ARR surgeons and compare long-term survival probability. Cumulative incidence curves with mortality as a competing risk were plotted to compare the rate of aortic valve reoperation.

Results: Of 1697 patients who met the study inclusion criteria, 944 underwent composite-valve conduit ARR and 753 underwent VSRR. The median age of the cohort was 57 years (interquartile range, 45-66 years), and 268 (15.8%) were female. Aortic insufficiency was present in 1105 patients (65.1%), and 200 of the procedures (11.8%) were reoperations. The indication for surgery was aneurysm in 1496 patients (88.2%) and dissection in 201 (11.8%). Among the 743 patients who underwent VSRR, 691 (92%) were operated on by ≥ 5 ARR surgeons and 62 (8%) were operated on by <5 ARR surgeons. In multivariable logistic regression, ≥5 ARRs (odds ratio, 3.33; 95% confidence interval, 2.34-4.73; P < .001) was associated with VSRR as the procedure of choice. Following IPTW, there was no significant difference between <5 ARR and ≥5 ARR surgeons in survival probability after VSRR (P = .59) or in the rate of aortic valve reoperation (P = .60).

Conclusions: In the setting of a high-volume aortic center, patients who undergo ARR are less likely to receive VSRR if operated on by a <5 ARR surgeon; however, VSRR may be safely performed by <5 ARR surgeons.

Keywords: aortic root replacement; inverse probability treatment weighting; surgeon volume; valve-sparing root replacement.

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Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
KM curve of IPTW balanced cohort.
Figure 1
Figure 1
Diagram depicting selection of patients who underwent aortic root replacement. ARR, Aortic root replacement; VSRR, valve-sparing root replacement; AS, aortic stenosis; AV, aortic valve; TAVR, transcatheter aortic valve replacement; CVC, composite valved conduit.
Figure 2
Figure 2
Kaplan-Meier curve (with 95% confidence interval) of inverse probability treatment weighting–balanced cohort among patients (rounded to the nearest whole number) who underwent valve-sparing root replacement. ARR, Aortic root replacement.
Figure 3
Figure 3
Cumulative incidence curve (with 95% confidence interval) of aortic valve reoperation among patients who underwent valve-sparing root replacement with mortality as a competing risk. ARR, Aortic root replacement.
Figure E1
Figure E1
Cubic spline of odds ratio (with 95% confidence interval) of undergoing valve-sparing root replacement versus yearly surgeon volume. VSRR, Valve-sparing root replacement.
Figure E2
Figure E2
Histogram of surgeon volume distribution.
Figure E3
Figure E3
Kaplan-Meier curve (with 95% confidence interval) of inverse probability treatment weighting–balanced cohort among patients (rounded to the nearest whole number) who underwent valve-sparing root replacement operated on by <5 aortic root replacement (ARR) surgeons or ≥5 ARR surgeons.
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References

    1. Nishimura R.A., Otto C.M., Bonow R.O., et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e1159–e1195. doi: 10.1161/CIR.0000000000000503. - DOI - PubMed
    1. Ommen S.R., Mital S., Burke M.A., et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical Practice Guidelines. J Am Coll Cardiol. 2020;76(25):3022–3055. doi: 10.1016/j.jacc.2020.08.044. - DOI - PubMed
    1. Holst K.A., Schaff H.V., Smedira N.G., et al. Impact of hospital volume on outcomes of septal myectomy for hypertrophic cardiomyopathy. Ann Thorac Surg. 2022;114(6):2131–2138. doi: 10.1016/j.athoracsur.2022.05.062. - DOI - PubMed
    1. Maron B.J., Dearani J.A., Maron M.S., et al. Why we need more septal myectomy surgeons: an emerging recognition. J Thorac Cardiovasc Surg. 2017;154(5):168–1685. doi: 10.1016/j.jtcvs.2016.12.038. - DOI - PubMed
    1. Kim L.K., Swaminathan R.V., Looser P., et al. Hospital volume outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: US nationwide inpatient database, 2003-2011. JAMA Cardiol. 2016;1(3):324–332. doi: 10.1001/jamacardio.2016.0252. - DOI - PubMed

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