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OBJECTIVE: We aimed to study the results of minimally invasive mitral valve repair performed by a consultant who introduced the technique at our institution and five young surgeons who were trained in mitral valve reapir directly through a video-assisted right chest approach.
METHODS: Data were analyzed for consecutive patients undergoing minimally invasive mitral valve repair who were operated on by one consultant or one of five trainees. Conversions were analyzed by intention to treat. Perioperative death or one or more of 6 adverse events constituted failure. Predicted risks of failure for individual patients were derived from the study population. Risk-adjusted control charts were plotted for each surgeons in effort to monitor the individual performance. In addition consultant and trainees operation were compared using standard tests.
RESULTS: The consultant operated on 355 patients and the trainees on 240 (81, 77, 39, 33 and 15, respectively for trainees 1-5). In hospital-mortalities were 1.3% in the trainess group and 0.8% in the senior surgeon group. Crude postoperative outcomes were similar between trainees and consultant. There were 17 conversions (consultant 11, trainees 6). The overall failure rate was 11% (12% for consultant's operations and 11% for trainees' operations), including 3 deaths (0.75%). Predicted and observed risks of failure were similar for all five surgeons. Risk adjusted control charts revealed that performance was the same or better for the trainess as for the consultant (figure 1).
CONCLUSIONS: Minimally invasive mitral valve repair can be safely taught to cardiac surgery trainees. Implementation of continuous performance monitoring for surgeons exposed to this technique is practicable.