Learning Minimally-Invasive Mitral Valve Surgery: A Cumulative Sum Sequential Probability Analysis of 3895 Operations from a Single High Volume Center
Background—Learning curves are vigorously discussed and viewed as a negative aspect of adopting new procedures. However, very few publications have methodically examined learning curves in cardiac surgery, which could lead to a better understanding and a more meaningful discussion of their consequences. The purpose of this study was to assess the learning process involved in the performance of minimally invasive surgery of the mitral valve (MIS-MV) using data from a large, single center experience.
Methods and Results—All mitral (+/-tricuspid, +/-atrial fibrillation ablation) operations performed over a 17-year period through a right lateral mini-thoracotomy with peripheral cannulation for cardiopulmonary bypass (n = 3907) were analysed. Data were obtained from a prospective database. Individual learning curves for operation time and complication rates (using sequential probability cumulative sum failure analysis) and average results were calculated. A total of 3895 operations by 17 surgeons performing their first MIS-MV operation at our institution could be evaluated. The typical number of operations to overcome the learning curve was between 75 and 125 operations. Furthermore, more than one such operation per week was necessary to maintain good results. Individual learning curves varied markedly proving the need for good monitoring and/or mentoring in the initial phase.
Conclusions—A true learning curve exists for MIS-MV operations. Although the number of operations required to overcome the MIS-MV learning curve is substantial, marked variation exists between individual surgeons. Such information could be very helpful in structuring future training and maintenance of competence programs for this kind of surgery.
- Received January 16, 2013.
- Revision received May 22, 2013.
- Accepted May 24, 2013.