Learning curve in minimally invasive mitral valve surgery: a single-center experience

Abstract Background Minimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for...

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Main Authors: Anh Tuan Vo, Dinh Hoang Nguyen, Sy Van Hoang, Khoi Minh Le, Thu Trang Nguyen, Vuong Lam Nguyen, Bac Hoang Nguyen, Binh Quang Truong
Format: Article
Language:English
Published: BMC 2019-12-01
Series:Journal of Cardiothoracic Surgery
Subjects:
Online Access:https://doi.org/10.1186/s13019-019-1038-0
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author Anh Tuan Vo
Dinh Hoang Nguyen
Sy Van Hoang
Khoi Minh Le
Thu Trang Nguyen
Vuong Lam Nguyen
Bac Hoang Nguyen
Binh Quang Truong
author_facet Anh Tuan Vo
Dinh Hoang Nguyen
Sy Van Hoang
Khoi Minh Le
Thu Trang Nguyen
Vuong Lam Nguyen
Bac Hoang Nguyen
Binh Quang Truong
author_sort Anh Tuan Vo
collection DOAJ
description Abstract Background Minimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately. Methods A total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method. Results MIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate. Conclusion MIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery. Trial registration The research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.
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spelling doaj.art-185843d2fdbb40cd8c4b0908e7170d352022-12-21T20:30:11ZengBMCJournal of Cardiothoracic Surgery1749-80902019-12-011411910.1186/s13019-019-1038-0Learning curve in minimally invasive mitral valve surgery: a single-center experienceAnh Tuan Vo0Dinh Hoang Nguyen1Sy Van Hoang2Khoi Minh Le3Thu Trang Nguyen4Vuong Lam Nguyen5Bac Hoang Nguyen6Binh Quang Truong7Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh CityDepartment of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh CityDepartment of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh CityDepartment of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh CityDepartment of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh CityDepartment of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh CityDepartment of Surgery, University of Medicine and Pharmacy at Ho Chi Minh CityDepartment of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh CityAbstract Background Minimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately. Methods A total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method. Results MIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate. Conclusion MIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery. Trial registration The research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.https://doi.org/10.1186/s13019-019-1038-0Learning curveMinimally invasive cardiac surgeryMitral valve surgery
spellingShingle Anh Tuan Vo
Dinh Hoang Nguyen
Sy Van Hoang
Khoi Minh Le
Thu Trang Nguyen
Vuong Lam Nguyen
Bac Hoang Nguyen
Binh Quang Truong
Learning curve in minimally invasive mitral valve surgery: a single-center experience
Journal of Cardiothoracic Surgery
Learning curve
Minimally invasive cardiac surgery
Mitral valve surgery
title Learning curve in minimally invasive mitral valve surgery: a single-center experience
title_full Learning curve in minimally invasive mitral valve surgery: a single-center experience
title_fullStr Learning curve in minimally invasive mitral valve surgery: a single-center experience
title_full_unstemmed Learning curve in minimally invasive mitral valve surgery: a single-center experience
title_short Learning curve in minimally invasive mitral valve surgery: a single-center experience
title_sort learning curve in minimally invasive mitral valve surgery a single center experience
topic Learning curve
Minimally invasive cardiac surgery
Mitral valve surgery
url https://doi.org/10.1186/s13019-019-1038-0
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