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(Circulation. 2007;116:e146.)
© 2007 American Heart Association, Inc.

Correspondence

Letter Regarding Article by Gammie et al, "Influence of Hospital Procedural Volume on Care Process and Mortality for Patients Undergoing Elective Surgery for Mitral Regurgitation"

Jeffrey H. Shuhaiber, MD; Hans Shuhaiber, MD

Department of Thoracic and Cardiovascular Surgery, Loyola University Stritch School of Medicine, Chicago, Ill

To the Editor:

We read with interest the article by Gammie et al¹ in the February issue of Circulation. The authors elegantly emphasize the known volume-outcome² effect and inverse relationship between case volume and mortality. One interesting caveat addressed in an editorial in Circulation in 2002³ was "what causes the leakage is fundamental to the outcome of valve repair." The authors were questioning the outcomes of ischemic versus nonischemic mitral valve disease. Furthermore, in a recent meta-analysis⁴ by etiological classification, there was strong evidence of differences in 30-day and total survival outcomes favoring repair for 3 disease groups (rheumatic, mixed, and degenerative). Surgery for ischemic mitral valve had lower 30-day mortality for repair than replacement, but no statistically significant difference in the overall survival was detected. On the basis of the tenets of etiology and acknowledging the hard work by the authors, we would appreciate finding out whether such a volume-effect outcome existed for the different mitral valve disease states.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 
1. Gammie JS, O’Brien SM, Griffith BP, Ferguson TB, Peterson ED. Influence of hospital procedural volume on care process and mortality for patients undergoing elective surgery for mitral regurgitation. Circulation. 2007; 115: 881–887.[Abstract/Free Full Text]

2. Urbach DR, Baxter NN. Does it matter what a hospital is "high volume" for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data. BMJ. 2004; 328: 737–740.[Abstract/Free Full Text]

3. Enriquez-Sarano M, Schaff HV, Frye RL. Mitral regurgitation: what causes the leakage is fundamental to the outcome of valve repair. Circulation. 2003; 108: 253–256.[Free Full Text]

4. Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg. 2007; 31: 267–275.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shuhaiber, J. H. Articles by Shuhaiber, H. Search for Related Content PubMed PubMed Citation Articles by Shuhaiber, J. H. Articles by Shuhaiber, H. Related Collections Valvular heart disease Other etiology