Improved Operating Room Efficiency For Minimally Invasive Mitral Valve Surgery At A Low-volume Centre
Monica Fowler, Jeffrey B. MacLeod, Alexandra M. Yip, Zlatko Pozeg, Craig Brown, Rand Forgie, Jean-Francois Légaré, Ansar Hassan.
New Brunswick Heart Centre, Saint John, NB, Canada.
BACKGROUND: Traditionally, conventional mitral valve repair or replacement (MVR), when compared with minimally invasive surgery (MIS) MVR, has been performed with shorter operative times. However, recent studies have demonstrated that parity in operative times may be achieved between the two techniques, albeit in high volume centers. The purpose of this study was to examine operative efficiency for MIS MVR in a low-volume cardiac surgical centre.
METHODS: All patients undergoing non-emergent, isolated, conventional or MIS MVR at the New Brunswick Heart Centre between 2011 and 2016 were included. Data specific to operative room efficiency included cross clamp (XC), cardiopulmonary bypass (CPB), skin-to-skin (SS) and total operative (TO) times. Patients were assigned to one of three eras as defined by the year in which their surgery was performed (2011-2012, 2013-2014, 2015-2016). Comparisons were made between conventional and MIS mitral valve surgery for the entire study period as well as within each era.
RESULTS: 130 patients were included (conventional: n=89; MIS: n=41). The number of cases was evenly distributed across eras. MIS patients were less likely to be ≥70 years (30.6% vs. 49.4%, p=0.04), and to have EF <40% (4.1% vs. 7.4%, p=0.01), previous cardiac surgery (4.1% vs. 21.0%, p=0.01) and urgent presentation (14.3% vs. 33.3%, p=0.02). Post-operatively, MIS cases were less likely to have atrial fibrillation (53.1% vs. 72.8%, p=0.02) and renal failure (2.0% vs. 18.5%, p=0.0006). In-hospital mortality did not differ between the two groups (0.0% vs. 5.1%, p=0.29). Median operative times were uniformly longer among MIS patients (XC 114min vs. 92, p=0.001; CPB 154 vs. 129, p=0.0003; SS 255 vs. 231, p=0.02; TO 357 vs. 299, p<0.0001). However, when analyzed by era, there was significant improvement in operative efficiency among MIS cases over time, with MIS operative times having been comparable to conventional operative times in 2015-2016 (Figure 1).
CONCLUSIONS: Improved operative efficiency may be achieved for MIS MVR in a low-volume centre. Further study is required to determine the factors underlying this improvement so that organizational learning strategies may be developed to help further improve OR team performance and decrease OR times.
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