Learning Curve from 100 Cases of Totally Thoracoscopic Mitral Valve Replacement

Learning Curve of TTMVR

Authors

  • Guan-hua Fang, MD Department of Cardiovascular Surgery, , Union Hospital, Fujian Medical University, Fujian Medical University, Fuzhou, China
  • Jin-hua Chen, MD Department of Cardiovascular Surgery, , Union Hospital, Fujian Medical University, Fujian Medical University, Fuzhou, China
  • Xiao-fu Dai, MD Department of Cardiovascular Surgery, , Union Hospital, Fujian Medical University, Fujian Medical University, Fuzhou, China

DOI:

https://doi.org/10.1532/hsf.3971

Keywords:

Totally thoracoscopic, Mitral valve replacement, Cumulative sum analysis, Learning curve

Abstract

Background: To investigate and analyze the learning curve of totally thoracoscopic mitral valve replacement and provide a quantitative reference for cardiac surgeons to carry out the operation step by step.

Methods: The clinical data were retrospectively analyzed of 100 consecutive patients with totally thoracoscopic mitral valve replacement successively performed by the same surgeon in a single center from May 2019 to June 2020. The learning curve was divided into 2 stages by using cumulative sum analysis, and relevant surgical parameters and perioperative indicators were analyzed.

Results: The first stage of the learning curve is the skill acquisition stage, which includes 1 to 40 surgical procedures. The second stage is the proficiency stage, involving 41 to 100 operations. Among the surgical parameters of the patients in the 2 stages, detectable improvements were observed in operative time, cardiopulmonary bypass time, cross-clamp time, and intraoperative injury. After surgery, the amount of drainage, length of hospital stay, blood creatinine levels, and oxygenation index 24 h after surgery were also significantly different between the 2 groups (all P < .05). The age and sex distributions of the patients were balanced, and there was no statistically significant difference in terms of conversion to median sternotomy between the 2 stages (P > .05).

Conclusions: Cumulative sum analysis was used to accurately analyze the learning curve of totally thoracoscopic mitral valve replacement, indicating that 40 cases are needed to master the technique.

References

Al Otaibi A, Gupta S, Belley-Cote EP, et al. Mini-thoracotomy vs. conventional sternotomy mitral valve surgery: a systematic review and meta-analysis. J Cardiovasc Surg (Torino) 2017;58:489-496.

Anyanwu AC, Adams DH. Should complex mitral valve repair be routinely performed using a minimally invasive approach? Curr Opin Cardiol 2012;27:118-124.

Bonaros N, Schachner T, Oehlinger A, et al. Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learning curves, and clinical outcome. Ann Thorac Surg 2006;82:687-693.

Chaput de Saintonge DM,Vere DW. Why don’t doctors use cusums? Lancet 197:1:120-121.

Cohn LH, Adams DH, Couper GS, Bichell DP, Rosborough DM, Sears SP, Aranki SF. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997;226:421-426.

Gammie JS, Zhao Y, Peterson ED, O’Brien SM, Rankin JS, Griffith BP. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2010;90:1401-1408, 1410.e1.

Greco E, Zaballos JM, Alvarez L, Urso S, Pulitani I, Sàdaba R, Juaristi A, Goiti JJ. Video-assisted mitral surgery through a micro-access: a safe and reliable reality in the current era. J Heart Valve Dis 2008;17:48-53.

Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation 2013;128:483-491.

Liu X, Chen X, Shen Y, et al. Learning curve for uniportal video-assisted thoracoscopic surgery lobectomy-results from 120 consecutive patients. J Thorac Dis 2018;10:5100-5107.

Ma ZS, Dong MF, Yin QY, Feng ZY, Wang LX. Totally thoracoscopic repair of atrial septal defect without robotic assistance: a single-center experience. J Thorac Cardiovasc Surg 2011;141:1380-1383.

Misfeld M, Borger M, Byrne JG, et al. Cross-sectional survey on minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2013;2:733-738.

Modi P, Hassan A, Chitwood WR Jr. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2008;34:943-952.

Murzi M, Kallushi E, Solinas M, et al. Minimally invasive mitral valve repair using transthoracic aortic occlusion. Ann Thorac Surg 1997;63:1477-1479.

Navia JL, Cosgrove DM 3rd. Minimally invasive mitral valve operations. Ann Thorac Surg 1996;62:1542-4.

Nissen AP, Nguyen S, Abreu J, Nguyen TC. The first 5 years: building a minimally invasive valve program. J Thorac Cardiovasc Surg 2019;157:1958-1965.

Ritwick B, Chaudhuri K, Crouch G, Edwards JR, Worthington M, Stuklis RG. Minimally invasive mitral valve procedures: the current state. Minim Invasive Surg 2013;2013:679276.

Rogers CA, Reeves BC, Caputo M, Ganesh JS, Bonser RS, Angelini GD. Control chart methods for monitoring cardiac surgical performance and their interpretation. J Thorac Cardiovasc Surg 2004;128:811-819.

Ryan WH, Dewey TM, Mack MJ, Herbert MA, Prince SL. Mitral valve surgery using the classical ‘heartport’ technique. J Heart Valve Dis 2005;14:709-714.

Svensson LG, Atik FA, Cosgrove DM, et al. Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg 2010;139:926-932.e1-e2.

Walther T, Falk V, Metz S, Diegeler A, Battellini R, Autschbach R, Mohr FW. Pain and quality of life after minimally invasive versus conventional cardiac surgery. Ann Thorac Surg 1999;67:1643-1647.

Wu X, Wei W, He Y, Qin H, Qi F. Analysis of the learning curve in mitral valve replacement through the right anterolateral minithoracotomy approach: a surgeon’s experience with the first 100 patients. Heart Lung Circ 2019;28:471-476.

Published

2021-10-08

How to Cite

Fang, G.- hua, Chen, J.- hua, & Dai, X.- fu. (2021). Learning Curve from 100 Cases of Totally Thoracoscopic Mitral Valve Replacement: Learning Curve of TTMVR. The Heart Surgery Forum, 24(5), E882-E886. https://doi.org/10.1532/hsf.3971

Issue

Section

Articles